Golden Age Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced visit at this facility for a One (1) year Required visit. LPA met with House Manager Yevgenya Movsesyan and explained the purpose of the visit. A tour of the physical plant was conducted at 8:46 AM. The facility has a total of five (5) bedrooms and two (2) bathrooms. One of the room is designated for staff use only. The facility is a one (1) storey building on the hill with the garage underneath. There is also a lift located just outside the garage for non-ambulatory and wheelchair bound resident. The facility fire cleared for six (6) non-ambulatory residents, one of which may be bedridden in Room #3. Hospice waiver for six (6) residents. There is only one entrance being utilized at the facility. The facility had submitted and approved Mitigation plan and Infection plan. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the family room. The facility maintains a comfortable temperature at 75°F. The carbon monoxide and smoke detector are tested and observed to be operational. Smoke detectors are hardwired and interconnected. Fire extinguisher was observed to be full and last bought on 07/11/26. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water at the facility. (continued on LIC 809-C) (continued from 809-C) There is a two (2) car port located at the front of the facility. There is a garage below the house which is currently being used as a laundry and storage area. The garage was locked during visit. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies, pesticides and other toxins are stored in the garage and observed to be locked and inaccessible to residents. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene products on each bathroom which is provided by the licensee. Staff Rooms: Staff rooms are locked. No medications are observed in the staff room. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 114.3°F to 115.5°F. There is sufficient supply of clean linen available in stock at the cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. Complete first aid kit is readily available. Client records: Client records are reviewed. All clients record reviewed appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. Disaster drill was last conducted on 05/26/26. Required posting observed in facility (complaint hot line poster). Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Jul 11, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced visit at this facility for a One (1) year Required visit. LPA met with staff Maria Rivera who called the Licensee Andranik Khunkayan and explained the purpose of the visit. The administrator is doing an assessment at this time. License's wife around twenty (20) minutes later. A tour of the physical plant was conducted at 12:36 PM. The facility has a total of five (5) bedrooms and two (2) bathrooms. One of the room is designated for staff use only. The facility is a one (1) storey building on the hill with the garage underneath. There is also a lift located just outside the garage for non-ambulatory and wheelchair bound resident. The facility fire cleared for six (6) non-ambulatory residents, one of which may be bedridden in Room #3. Hospice waiver for six (6) residents. There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation plan and Infection plan. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the family room. The facility maintains a comfortable temperature at 75°F. The carbon monoxide and smoke detector are tested and observed to be operational. Smoke detectors are hardwired and interconnected. Fire extinguisher was observed to be full and last bought on 06/03/25. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water at the facility. (continued on LIC 809-C) (continued from 809-C) There is a two (2) car port located at the front of the facility. There is a garage below the house which is currently being used as a laundry and storage area. The garage was locked during visit. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies, pesticides and other toxins are stored in the garage and observed to be locked and inaccessible to residents. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene products on each bathroom which is provided by the licensee. Staff Rooms: Staff rooms are locked. No medications are observed in the staff room. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 110.3°F to 117.2°F. There is sufficient supply of clean linen available in stock at the cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. Complete first aid kit is readily available. Client records: Client records are reviewed. All clients record reviewed appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. Disaster drill was last conducted on 05/28/25. Required posting observed in facility (complaint hot line poster). Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Jul 15, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Gary Tan conducted a Pre-Licensing Inspection with the Administrator Hasmik Sargsyan The applicant is "Hay Multigroup Inc.,". A fire clearance was approved on 03/21/24 for six (6) non-ambulatory residents, one (1) of which may be bedridden on Room #3. The applicant has an approved hospice waiver for six (6) residents. The facility has a total of five (5) bedrooms and two (2) bathrooms. One of the room is designated for staff use only. The facility is a one storey building on the hill with the garage underneath. There is also a lift located just outside the garage for non-ambulatory and wheelchair bound resident. A tour of the physical plant was initiated at approximately 8:45 AM and the following was observed: KITCHEN: The facility has a Kitchen that is equipped with a refrigerator, microwave, stove, dishwasher and sink. There was an adequate supply of perishable and nonperishable food. Knives were observed locked in a kitchen drawer. Cleaning supplies and other toxins will be stored in the cabinet in the bedroom hallway which was locked during visit. BEDROOMS: There are four (4) bedrooms designated for client's use, two (2) shared and two (2) private. The applicant furnished the resident bedrooms with beds, night stand, chairs, dressers, bedding and linen. The bedrooms have sufficient lighting and storage. BATHROOMS: The facility has two (2) shared bathrooms for clients' use. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water temperature was measured at a range of 111.2°F to 115.4°F. LAUNDRY ROOM: The laundry room is located in the garage. Laundry detergents and other cleaning agents were kept in the garage which was locked during visit. (continued on LIC 809-C) (continued from LIC 809) COMMON AREAS: These included the living room and the dining area. Living room was furnished with chairs and side tables. The living room area was furnished with a television, a coffee table and sofas to sit the capacity of the facility. There were no visible immediate hazards. Cleaning supplies and chemicals are stored and locked in the garage below. There is a working telephone line and internet accessible to residents. Dual smoke/carbon monoxide alarms were tested and observed to be operable. Fire extinguisher is located in the kitchen and last bought on 03/21/24. MEDICATIONS: The medication cabinet is located in the staff room and observed to be locked. A complete first aid kit is located in staff room. Staff/Resident Records: Staff and resident records will be kept in the locked cabinet inside the staff room. SURROUNDING GROUNDS: The stairs, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The front yard of the facility has a covered patio and backyard furniture to accommodate the residents. The Garage is attached to the house underground, locked and inaccessible to residents. The garage is currently being used as Laundry area, PPE, tools and old equipment storage. There is no body of water in the facility. Component III was conducted with Licensee representative Andranik Khunkayan his wife Jenny Movsesian and the Administrator. No deficiencies were observed during visit.. This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. You are not allowed to take additional resident until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, May 16, 2024

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Initial Capacity: 6 Census (if any clients in care): 4 COMP II Participants: Andranik Khunkayan, Applicant Hasmik (Jasmine) Sargsyan, Administrator Interview Method: Telephone interview On April 1, 2024 at 2:00 PM, Applicant and Administrator participated in COMP II. Identification of the Applicant and Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant and Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. During COMP II, CAB Analyst confirmed Applicant and Administrator’s understanding of following areas: 1. Facility Operation: License type, client/resident populations, and program. 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Applicant and Administrator. Report sent via email and informed to return sign copy back to CAB by end of business day today or tomorrow tomorrow.the state’s words, verbatim · CDSS document, Apr 2, 2024