Grant Serenity Homes of Sierra Madre

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Staff#1 upon arrival. Administrator Ani Karapetyan and the facility nurse Diana Castellanos joined shortly after. LPA explained the reason of visit to Diana, the facility nurse. The annual fees are current. The facility is licensed to serve six (6) non-ambulatory residents over the age of 60, of which six (6) may be bedridden, and has a hospice waiver for six (6) residents. The facility is a single home in a residential area and consists of a kitchen, a living/dining room, with six (6) resident rooms, two (2) bathrooms, a laundry area, a detached garage, a front yard, and a backyard. Today’s inspection consisted of applying CARE tool, conducting physical plant tour, reviewing staff/residents records, checking residents’ food supply/medication, and interviewing staff/residents. Infection Control: Facility maintains an infection control plan was on file. Staff were observed practicing safe hand washing. Hand sanitizing was observed throughout. Hygiene supply and sanitizing materials were observed. Personal protective equipment was observed. Operational Requirements: Facility maintains a plan of operation. Facility has a current liability insurance. Facility is operating within the license. Physical Plant/Environmental Safety: Physical plant was conducted with Staff#1 (S1). Facility was observed in good repair indoors and outdoors. (-continued on LIC 809C) Living room/dining room were clean, and provide sufficient sitting area, and lighting. Kitchen area was clean; sharps were locked in drawers in the kitchen. Medications were centrally stored and locked. Cleaning supplies were stored in locked drawer/cabinets. Laundry area was observed in good repair. Four (4) resident rooms were observed clean with sufficient lighting, furniture, and bedding supplies. Full bed rails were observed in bedroom #1, #3, #4, whose residents were either having physician orders or hospice admission records. Bathroom was observed clean in working conditions with grab bars and skid mats in the showers. Water temperature was tested at 115.5 degrees F., which is within the required 105-120 degrees F. Carbon Monoxide/Smoke detectors were tested and operable. Fire extinguishers were mounted on the wall in the kitchen and last checked on 10/15/25. Ramps, exit doors, and passageways are free of debris and obstructions. Personnel / Resident Records/Staff Training: Administrator certificate is current with expiration date on 6/28/27. Staff records were available for review. Residents records were available for review. Resident files contained medical assessment, TB clearance, admission agreement, an appraisal, a needs and care plan. Disaster Preparedness: Emergency Disaster plan (LIC 610D 3/19) was last reviewed on 3/15/25. Last Emergency drill was conducted on 02/20/26. The quarterly emergency drills have been conducted since last annual inspection conducted. Residents with Special Health Needs: Postural support/bed rails were observed. Copies of family's request, physician orders and hospice admission were observed in residents files. There are no residents with restricted health conditions under care. Facility follows dementia regulations. Medical assessments for residents with dementia were observed within the last 12 months. Auditory devices were observed in each exit door. Facility currently has two residents on hospice and keeps hospice plan on file. Exit: No deficiencies were noted during this visit per California Code of Regulations, Title 22, Division 6. Exit interview was conducted with Administrator Ani Karapetyan and LIC 809s were provided.the state’s words, verbatim · CDSS document, Mar 3, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Lourdes Sandoval caregiver and explained the reason for the visit. Facility is licensed to serve 6 non-ambulatory residents over the age of 60, of which (6) may be bedridden, and has a hospice waiver for (6). The facility is a single home in a residential area and consist of a kitchen, a living/dining room, with 6 resident rooms, 2 bathrooms, a laundry area, a detached garage, a front yard, and a back yard. LPA reviewed the following CARE inspection tool domains during this visit: Infection Control: Infection control plan was reviewed which meets current regulations. Hand sanitizer and proper sanitation was observed during the visit. There is a responsible person and emergency training was provided to staff. Personal protective equipment was observed. Plan was last reviewed on 6/10/24. Operational Requirements: Facility maintains a plan of operation. Facility has a current liability insurance. Facility is operating within the license. Physical Plant/Environmental Safety: LPA conducted a tour of the facility with Lourdes Sandoval and observed the following: Facility was observed in good repair indoors and outdoors. Living room/dining room is clean, and providing sufficient seating area, and lighting. Kitchen area is clean and inaccessible to residents, sharps, medication, and cleaning supplies were observed locked in cabinets in the kitchen area. Six (6) resident rooms were observed clean with sufficient lighting, furniture, and bedding supplies. Full bed rails were observed in bedroom #2 and #3. (CONTINUED ON LIC 809C) Two (2) Bathrooms were observed clean in working condition with grab bars. Bathroom #2 was observed with no skid mat in the shower. Water temperature was tested between 111.5 - 112.5 degrees F., which is within the required 105-120 degrees F. Laundry room was observed in good repair. Activities were observed in a cabinet in the living room. Front yard and back yard have a shaded seating area. Garage is used to stored additional food supplies. There are no large bodies of water in the facility. Carbon Monoxide/Smoke detectors were observed, tested, and in working condition. Fire extinguishers were observed and last checked on 10/8/24. Ramps, exit doors, and passageways are free of debris and obstructions. Staffing: Designee staff Diana Castellano arrived at the facility shortly after. Staff have current CPR/First Aid training on file. Night staff have been provided emergency training. Sufficient staff were observed. Personnel Records/Staff Training: Administrator certificate was observed for Ani Karapetyan #6066778740 exp. date: 6/28/25. All staff records were available for review. LPA reviewed a total of 5 staff files which included medical assessment, TB clearance, background clearance, and training. Resident Rights/Information: Personal Rights, Let Us No poster (PUB 475), and Local Ombudsman posters were observed posted in the kitchen and living room. Planned Activities: Activity materials were observed. Per staff a contractor visits the home to provide music therapy and activities are provided daily by staff. Outdoor area has a seating area to promote outdoor activities. Food Service: Sufficient food supplies were observed of perishables for at least 2 days and non-perishables for at least 7 days. There are currently no residents on special diets. No pest was observed. Incidental Medical and Dental: There is an area designated to centrally stored medication in a cabinet with a lock in the kitchen. Medications are label and in their original containers. Staff have a log for PRN medications provided. Resident Records/Incident Reports: Residents records were available for review. LPA reviewed a total of 5 resident files which contained medical assessment, TB clearance, admission agreement, an appraisal, a needs and care plan, medication sheet. Disaster Preparedness: Emergency Disaster plan (LIC 610E 3/19) was last reviewed on 3/5/25. Last Emergency drill was conducted on 1/5/25. Record reviewed showed facility conducts quarterly drills. Residents with Special Health Needs: Postural support/bed rails were observed and physician's request were observed in residents files. (CONTINUED ON LIC 809C) However, two residents; resident #1(R2) was observed to have four half bed rails, two in each side of the bed and #3(R3) was observed to have full bed rails in the bed. R1 and R3 are currently not receiving hospice services. There are no residents with restricted health conditions under care. Facility is following dementia regulations. Medical assessments for residents with dementia were observed within the last 12 months. Auditory devices were observed in each exit door. Facility currently has one resident on hospice and keeps hospice plan on file. Deficiencies were noted per Title 22 Regulations and a technical violation was noted. Exit interview was conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 1, 2025

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst(s)(LPA) Mary Flores and Christian Gutierrez conducted an unannounced annual visit at the facility using the inspection CARE tool. LPAs met with Lourdes Sandoval caregiver and explained the reason for the visit. Facility is licensed to serve 6 non-ambulatory residents over the age of 60, of which (6) may be bedridden, and has a hospice waiver for (6). The facility is a single home in a residential area and consist of a kitchen, a living/dining room, with 6 resident rooms, 2 bathrooms, a laundry area, a detached garage, a front yard, and a back yard. LPAs conducted a tour with Lourdes Sandoval and observed the following: Facility is in good repair indoor and outdoor. Living/dining room has furniture and in good repair. Kitchen is clean, in good repair, and sufficient food was observed for at least 2 day of perishables and 7 days of non-perishables. Cleaning supplies and medication was observed locked in the kitchen. Each resident room (6) has sufficient lighting, furniture, and bedding supplies. Each bathroom (2) is clean, in good repair, and water temperature was tested between 109.2 -115.1 degrees F. which is within the required 105-120 degrees F. Laundry room was observed in good repair. Carbon Monoxide/Smoke detectors were observed and tested. Additional supplies are stored in the garage and shed. Garage provides a rest area for staff. Backyard and front yard are clean and provide shaded sitting area. No large bodies of water were observed. LPAs reviewed files and medication for 5 residents, and 5 staff files. Emergency Disaster plan and Infection control plan were reviewed. Last fire drill was conducted on 1/8/24. Administrator certificate was observed for Nvard Gevorkian #605043740 exp. 12/23/24. No deficiencies were noted during this visit. Exit interview was conducted with Nvard Gevorkian and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 16, 2024