Grant Serenity Homes of Sf Valley

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra arrived at the facility unannounced to conduct the required annual visit. Upon arrival LPA was greeted by staff, and the LPA explained the reason for the visit. Staff contacted the Administrator on the phone to inform them of the visit. The Administrator Hasmik Mheryan arrived shortly thereafter. The LPA and the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last serviced on 09/04/2025. The LPA observed required postings throughout the common space. KITCHEN: The kitchen was observed to be clean and the appliances and fixtures functional during the time of visit. The LPA observed a sufficient amount of perishable and at the facility. Sharp objects are stored in a locked cabinet drawer in the kitchen to the right of the stove. No cleaning supplies or toxins are stored under the sink. Non-perishable food pantry was observed to be stocked with sufficient pantry items. The non-perishable emergency supply of food was observed to be stored in the garage area in a locked cabinet. LAUNDRY ROOM: Laundry room is located to the left of the refrigerator within the kitchen area. It was observed to be locked and inaccessible to residents in care at the time of the visit. LPA observed cleaning supplies and other toxins stored in this location. It was observed to be inaccessible to residents in care. Continues on LIC 809C... BEDROOMS: The six (6) private residents’ bedrooms were properly furnished with a bed, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. BATHROOM: The facility has one bathroom for residents and staff. The LPA observed bathroom to have grab bars and non-skid mats. The hot water was measured in each bathroom between 110 - 113 degrees Fahrenheit. OUTDOOR AREA: The backyard has a shaded outdoor area equipped with furniture for client use. No bodies of water were observed. The LPA observed an additional building at the far end of the property behind the garage. The outdoor area behind the detached garage is inaccessible to residents in care at this time. Passageways were free and clear from obstruction. LPA observed shaded seating area with appropriate outdoor furniture in the front of the facility as well. RECORDS: Records review began at 11:15 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 12:25 p.m.; medications are centrally stored and locked in a cabinet and small refrigerator in the office area; medications are labeled and were checked for expiration dates. The LPA was able to conduct a random audit of the bubble packet medications, and there were no errors observed during the medication review. The LPA reviewed the following documents: -LIC500 Personnel Report -LIC9020 Client Roster -Certificate of Liability - Disaster/Emergency Drills Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 22, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Sandra arrived at the facility unannounced to conduct a required annual visit at 11:05 a.m. Upon arrival LPA was greeted by staff, and the LPA explained the reason for the visit. Staff contacted the Administrator on the phone to inform them of the visit. The Administrator arrived shortly thereafter. The LPA and the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last serviced on 10/19/2023. The LPA observed required postings throughout the common space. KITCHEN: The kitchen appeared to be clean and the appliances and fixtures functional during the time of visit. The LPA observed a sufficient amount of perishable and at the facility. Sharp objects are stored in a locked cabinet drawer in the kitchen to the right of the stove. No cleaning supplies or toxins are stored under the sink. Non-perishable food pantry was observed to be stocked with sufficient pantry items. The non-perishable emergency supply of food was observed to be stored in the garage area in a locked cabinet. LAUNDRY ROOM: Laundry room is located to the left of the refrigerator within the kitchen area. It was observed to be locked and inaccessible to residents in care at the time of the visit. LPA observed cleaning supplies and other toxins stored in this location. It was observed to be inaccessible to residents in care. BEDROOMS: The residents’ bedrooms were properly furnished with a bed, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Continues on LIC 809C... BATHROOM: The facility has one bathroom for residents and staff. The LPA observed bathroom to have grab bars and non-skid mats. The hot water was measured in each bathroom between 110 - 113 degrees Fahrenheit. OUTDOOR AREA: The backyard has a shaded outdoor area equipped with furniture for client use. No bodies of water were observed. The LPA observed an additional building in the far end of the property behind the garage. Next to the detached garage the LPA observed an empty pool that was gated and inaccessible to residents in care. The outdoor area behind the detached garage is inaccessible to residents in care at this time. Passageways were free and clear from obstruction. LPA observed shaded seating area with appropriate outdoor furniture in the front of the facility as well. RECORDS: Records review began at 1:15 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 12:25 p.m.; medications are centrally stored and locked in a cabinet and small refrigerator in the office area; medications are labeled and were checked for expiration dates. The LPA observed that the medications are not being documented on the Centrally Stored Medications and Destruction Record form (LIC 622), however the medications are being documented in facility created form. The Administrator understood that the facility must document the medications in the required Department’s form (LIC 622). The Administrator will submit the completed forms (LIC 622) for four residents to the LPA by 10/07/2024. The LPA was able to conduct a random audit of the bubble packet medications, and there were no errors observed during the medication review. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPA reviewed the following documents:- LIC500 Personnel Report &LIC9020 Client Roster, Certificate of Liability Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 2, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit at 9:20am. Upon arrival LPA met with Administrator Ruzanna Sukiassyan and explained the reason for the visit. At approx. 09:50am, LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Facility is a single-story residence and consists of a total of six (6) bedrooms and one (1) bathroom. During physical plant tour LPAs observed the required postings throughout the facility. At approx. 9:30am, LPA observed resident having breakfast. The kitchen appeared to be clean and the appliances and fixtures functional during the time of visit. LPAs observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects are stored in a cabinet in the kitchen to the right of the stove. No cleaning supplies or toxins are stored under the sink. Laundry room located to the left of the fridge. It was observed to be inaccessible to residents in care at the time of the visit. LPA observed cleaning supplies and other toxins stored in this location. Non-perishable food panty located to the left of the laundry room. It was observed to be inaccessible to residents in care. LPA observed a sufficient supply of extra non-perishable food stored in this location. The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed bathroom to be clean, properly supplied and had functional fixtures. LPA observed bathroom to have grab bars and non-skid mats. The hot water was measured in each bathroom between 110 - 113 degrees Fahrenheit. Continued from 809 LPA observed common areas which, included the living room, office area and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Planned activities and games were on display on a shelf located near bedroom #2. Medications are stored in a locked cabinet and locked fridge near the office area. LPA observed both to be inaccessible to residents in care. There is a dedicated area for the posting of required documents directly by the entry way into the kitchen. The common areas were observed to be properly furnished and relatively clean at the of the visit. LPA observed appropriate signage regarding infection control posted throughout the facility. LPA observed sanitizer readily available in areas with high touch surfaces. Common room furniture was observed to be in good condition. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detectors were operational at the time of the visit. Fire extinguishers were observed fully charged and last serviced on 12/29/2022. Between 09:50am - 10:40am LPA observed an entertainer singing with all the residents. All exits in the facility have functioning auditory devices and were operational at the time of the visit. LPA observed the back patio, with a shaded area and appropriate outdoor furniture for resident use. LPA observed a detached garage. Disinfectants, cleaning solutions, incontinent supplies are stored inaccessible to residents in this area. LPA also observed 7 day emergency food supply kept in the garage as well. Storage room in the rear of the garage was observed to store a sufficient amount of PPE. Behind the garage LPA observed (3) buildings for storage. The building closest to the detached garage was observed to store art pieces. The other (2) storage buildings at the rear of the facility stored decorations, medical equipment, other supplies for facility use and extra art pieces. Next to the detached garage LPA observed an empty pool that was gated and inaccessible to residents in care. The outdoor area behind the detached garage is inaccessible to residents in care at this time. There is a gate on the side of the facility designated for an emergency exit. Passageways were free and clear from obstruction. LPA observed shaded seating area with appropriate outdoor furniture in the front of the facility as well. Records review began at 10:30 am, five (5) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. At approx. 11:30am, Five (5) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were observed to be in order at this time. Continued from 809-C Medications: Medications review began at approximately 01:00pm. The medications are centrally stored in a locked storage cabinet near the office area. Medications were observed to be properly documented on the centrally stored medications and destruction record. Infection Control : Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of a communicable disease. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room or relocate residents if the facility has a confirmed case of a communicable disease. The facility’s policies and procedures as it pertains to infection control are adequate at this time. Between 2pm - 2:30pm the LPA interviewed three (3) staff members and attempted to interview five (5) residents. LPAs obtained the following documents - Census, Staff schedule, Administrator Documents and updated Limited Liability insurance. Exit interview conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Oct 5, 2023