Grant Serenity of Del Mar

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Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Galarza generated this Case Management - Deficiencies report in conjunction with complaint control # 28-AS-20260520145403 pertaining to observations made during the physical plant inspection of resident rooms. The purpose of the report was explained to Designee Diana Castellanos. Observations: Resident (R1's) bed had full bed rails. Residents (R2 & R3's) beds had three-quarter length rails. Pursuant to Title 22, a deficiency was cited. An exit interview was conducted and a copy of the report and appeal rights were issued to Designee Diana Castellanos.the state’s words, verbatim · CDSS document, May 22, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: May 22, 2026

Postural Supports. Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Based on observation, R1's bed has full bed rails, and residents (R2 & R3's) beds had three-quarter length and none of the residents are enrolled in hospice care, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 22, 2026

Plan of correction: Staff removed the bed rails during the visit. Resident files were reviewed. LPA confirmed that all three residents have current half rail bed physician orders. **Citation cleared during the visit.

Allegation investigated: Staff did not prevent resident in care from sustaining multiple pressure injuries while in care.

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 12/05/2025 regarding the above allegation. During today’s visit LPA Ramirez was greeted by Gohar Armani and explained the purpose of the visit. SEE 9099-C for continued report. Substantiated The investigation consisted of the following: LPA Ramirez requested and obtained a copy of Resident/Client Roster, copies of Resident#6 (R6): Admission Agreement, Medical Assessment, Identification and Emergency Information, Appraisal/Needs and services plan, Medication Administration Record (MAR) for March – May 2025, Vital logs Jan-April 2025, Repositioning/Diaper Change Log for March, April and May 2025, R6's Hospital Medical Records, R6's Home Health Medical Records, R6's Medical Records copy of Staff Roster, Staff#1 - 5 interviews (S1 – S5) conducted by LPA Ramirez, Resident#2, 5 interviews (R2, R5) conducted by LPA Ramirez, Interview with resident#4’s (R4) family conducted by LPA Ramirez, Interviews conducted by Community Care Licensing-Investigations Branch, Investigations Branch-Investigation Report completed 10/7/2025, and physical plant tour. The investigation revealed the following: regarding the allegation “Staff did not prevent resident in care from sustaining multiple pressure injuries while in care.” Interviews conducted by Community Care Licensing-Investigations Branch corroborated this allegation. Records reviewed by Community Care Licensing-Investigations Branch revealed that R6 was discharged from a local hospital on 03/19/2025 with a Stage I coccyx pressure injury and R6 was admitted to the facility on 03/19/2025. Records reviewed by Community Care Licensing-Investigations Branch revealed that in April of 2025, R6's Home Health and R6's physician noted several pressure injuries had developed on R6’s feet, ranging from Stage II to unstageable, and R6’s coccyx pressure injury had progressed to Stage II. On 04/29/2025, R6 was taken to a local hospital due to worsening pressure injuries. During the examination of R6, attending physician noted the pressure injuries were likely caused by the care at the facility. Interview conducted by Community Care Licensing-Investigations Branch with R6's Home Health nurse revealed that R6’s pressure injuries continued to worsen and develop new pressure injuries due to the staff’s inability to follow repeated education and instructions on pressure injury care and that with frequent repositioning, R6’s pressure injuries “could have been avoided.” R6's Home Health nurse revealed that on one occasion, staff were observed applying cream to R6’s coccyx injury but staff did not apply the dressing to keep the area dry, as instructed. Interviews conducted by Community Care Licensing-Investigations Branch with facility staff revealed that staff were not repositioning R6 often as needed. The information gathered during this investigation noted that R6’s pressure injuries worsened due to staff not following instructions pertaining to proper care and lack of timely repositioning. Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. One (1) deficiency was issued. The licensee was informed that a civil penalty might be assessed based on the Health & Safety Code 1569.49(e) or (f), or 1548(e) or (f), or 1568.0822(e) or (f). Exit interview was conducted. A copy of this report, 9099-D, and appeals rights were provided. The investigation revealed the following: regarding the allegations “Staff handled resident in a rough manner resulting in an injury.” Interviews conducted by LPA Ramirez with five (5) staff did not corroborate this allegation. Staff interviews revealed R6 would become combative and aggressive with staff when staff tried to assist R6 with ADL’s (activities of daily living). Staff revealed R6 would get agitated and combative when staff attempted to put shoes on R6, as a result staff revealed they would allow R6 “space” and contacted R6’s family to inform them of R6’s refusal to wear shoes for walking and combativeness. Six (6) out of the six (6) staff interviewed denied handling R6 in a rough manner that resulted in an injury. LPA Ramirez reviewed R6’s facility file and did not observe facility incident reports that indicated R6 sustained an injury due to staff handling R6 in a rough manner. LPA Ramirez interviewed R4’s family and they revealed that they are in the facility most days for several hours and have never witnessed staff being aggressive or rough with residents. Two (2) out of the two (2) residents interviewed denied this allegation. Interview with R2 revealed that staff were “caring” with all the residents. Three (3) out of the five (5) residents in care were unable to be interviewed due to cognitive impairments. Due to cognitive impairments, R6 was unable to be interviewed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. “Staff shared resident’s medication between other residents in care.” Interviews conducted by LPA Ramirez with five (5) staff did not corroborate this allegation. Staff interviews revealed no medication is shared between residents because each resident has a different prescription and strength. Two (2) out of the two (2) residents interviewed denied this allegation. Interview with R4’s family revealed that R4 has always received their medication in a timely manner and medication was administered according to R4’s physician’s order. Three (3) out of the five (5) residents in care were unable to be interviewed due to cognitive impairments. Due to cognitive impairments, R6 was unable to be interviewed. During the record review, LPA Ramirez examined the medication administration record (MAR) for five (5) out of the five residents in care and did not observe any discrepancies. During facility tour, LPA Ramirez conducted an observation of staff administering medication to residents in care and noted no irregularities or concerns. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. SEE 9099-C for continued report “Staff did not implement proper infection control practices.” Interviews conducted by LPA Ramirez with five (5) staff did not corroborate this allegation. Staff interviews revealed that staff clean and disinfect high trafficked areas at least every 2 hours and staff always wear gloves while providing first aid, toileting and when bathing residents. During record review of personnel records, LPA Ramirez observed annual staff training on infection control practices. LPA Ramirez examined the facility approved Infection Control Plan. During facility tour, LPA Ramirez conducted an observation of staff administering medication to residents in care and noted staff were wearing gloves and a face mask. LPA Ramirez observed the facility to be free from odors and did not observe potential hazards. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. “Staff covered resident’s face with a beanie.” Interviews conducted by LPA Ramirez with five (5) staff did not corroborate this allegation. Two (2) out of the two (2) residents interviewed denied this allegation. Interview with R4’s family revealed that they have only observed staff to be professional with their loved one and other residents in the facility. Three (3) out of the five (5) residents in care were unable to be interviewed due to cognitive impairments. Due to cognitive impairments, R6 was unable to be interviewed. During record review of personnel records, LPA Ramirez did not observe documentation of staff being reprimanded treatment of residents in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies were cited for these allegations. Exit interview was conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 5, 2025 · control 28-AS-20250626151821

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Dec 8, 2025

(a) residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: staff did not following instructions pertaining to pressure injury care which resulted in R6's worsening pressure injuries. This poses an immediate risk to the health, safety, or personal rights of persons in care.the state’s words, verbatim · CDSS document, Dec 5, 2025

Plan of correction: Licensee will develop and submit a plan outlining the procedures and protocols for ensuring that staff adhere to specific care instructions for residents. Plan must be received by 12/08/25 via email to LPA Ramirez. Kimberly.ramirez@dss.ca.gov

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierres conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Caregiver Gohar Armani and explained the reason for the visit. Licensee Nvard Gevorkian arrived shortly. The facility is licensed to serve 6 residents, 60 years and over; of which 6 may be non-ambulatory and 1 bedridden in bedroom #1 with a hospice waiver for (6). Facility consists of a living room, a dining room, a kitchen, 4 resident bedrooms, 2 bathrooms, a laundry area, a backyard, and a detached garage. LPA toured the facility and observed the following: Each resident bedroom has the required furniture and bedding. Th Smoke detectors were observed throughout the facility and are properly operating. LPA observed carbon monoxide detector not working. The facility has one (1) fully charged fire extinguishers which is kept in laundry area in kitchen. Cleaning supplies and toxic substances were observed to be inaccessible in locked kitchen drawers. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Facility was observed to have sufficient supply of 2 days perishable & 7 days non-perishable foods. LPA observed medication crushed and being put in R6’s cottage cheese. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. Each bathroom was observed clean, with grab bars and skid mats. Clean towels and extra clean linen are in each resident’s room. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents outside. Passageways and exits are free of obstruction. Garage had extra food and hygiene supplies. SEE LIC 809C Five (5) staff files were reviewed and included criminal clearance record, and health screening with TB. Four (4) out of Six (6) residents files were reviewed and included physician’s reports and appraisal needs and service plan. R6 was missing physician report and R4 was missing appraisal needs and service plan. Fire/earthquake drill was conducted July 25th, 2025. The medications are centrally stored and locked in a cabinet in kitchen. While conducting medication review LPA discovered medication missing along with medication administration record (MAR) log discrepancy. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809Ds. Exit interview was held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 20, 2025

Allegation investigated: Facility staff did not assist resident with dental hygiene Facility staff did not meet resident's incontinence care needs Illegal Eviction

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA met with Gohar Armani and explained the reason for the visit. The investigation consisted of the following: On 4/1/25 conducted an initial complaint investigation visit and requested copies of staff/resident roster. LPA interviewed 4 residents, 2 responsible parties, and 3 staff and requested the following documents: medical assessment, identification and emergency information sheet, admission agreement, pre-appraisal, needs and care plan for resident #1(R1). On 4/3/25 LPA Flores received the requested documents. On 4/17/25 LPA Flores delivered findings for the above allegations. The investigation revealed the following: Regarding allegation: Facility staff did not assist resident with dental hygiene. It is alleged resident was not assisted with brushing their teeth which developed into dental issues. (CONTINUED ON LIC 9099C) Unsubstantiated Interviews conducted with residents revealed 1 out of 4 residents stated facility staff does not assist with brushing their teeth, and 3 out 4 residents were unable to answer due to cognitive skills. Responsible parties’ interviews stated that have observed residents being assisted with dental hygiene during their visits. Interviews with staff revealed residents are assisted with dental hygiene twice a day in the morning and evening. Documents reviewed revealed per needs and care plan dated: 6/6/24 and physician’s report dated: 6/28/24, R1 needed assistance with most activities of daily living (ADLs) except for feeding. Needs and care plan does not specify the number of times per day of assistance with dental hygiene needs. Although, R1 may have developed dental issues, per interviews conducted and documents reviewed there is not sufficient evidence to determine the dental issues were cause due to lack of assistance of dental hygiene to R1. Therefore, the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Regarding allegation: Facility staff did not meet resident’s incontinence care needs. It is alleged resident had many urinary track infections (UTI) due to staff not changing resident soil adult underwear. Interviews conducted with residents revealed, 1 out of 4 residents interview stated staff assist with incontinence care in a timely manner, 3 out of 4 residents were unable to answer due to cognitive skills. Responsible parties’ interview stated they do not have concerns on incontinence care provided to the residents in care. Interviews conducted with staff revealed, staff check on the residents at least every two hours and change the residents as needed. Per documents reviewed; Physician’s report dated: 6/28/24 notes R1 needs assistance with ADLs. Per needs and care plan dated 6/6/24 R1 will be assisted with change adult undergarment daily as needed. Nurse’s notes on 7/2/24 and 7/19/24 do not note concerns on incontinence care, or appearance of R1. One nurse note/communication was noted on 9/12/24 regarding concerns for a UTI. Although R1 may have had developed a UTI there is not sufficient evidence to determined that the UTI were cause due to lack of incontinence care provided to R1. Therefore, the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. (CONTINUED ON LIC 9099C) Regarding allegation: Illegal eviction. It is alleged resident was asked to leave the facility due to a higher level of care. Interviews conducted with residents revealed, 1 out of 4 residents stated to be aware of residents’ rights and means to an eviction, 3 out of 4 residents were unable to answer due to cognitive skills. Interviews conducted with responsible parties stated to be aware eviction and higher level of care process. Interviews with administrator and staff revealed R1’s responsible was not provided an eviction notice. Per documents reviewed, R1 was admitted to the facility on 7/2/24. Communication between facility and responsible party show that on 1/27/25 licensee communicated with responsible party via email about R1’s relocation for higher level of care for treatment and that the facility could hold R1’s bed if responsible party desires. R1’s responsible party responded and took the communication as a 30 day notice. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with Gohar Armani and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 17, 2025 · control 28-AS-20250324121724

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced case management visit to note deficiencies during a complaint investigation visit. LPA met with Gohar Armani and explained the reason for the visit. On 4/17/25 LPA conducted an investigation visit in which it was discovered that on 1/27/25 licensee communicated with Resident #1(R1)'s responsible party and requested R1 was transfer to a higher level of care for treatment. During file review there was no medical assessment by a medical professional or primary physician to note R1 needed a higher level. R1's last physician's report dated 6/28/24 does not note a higher level of care needed. Therefore, a deficiency is noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Gohar Armani and a copy of this report, LIC 809D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 17, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87505 · Plan of correction due date: Apr 24, 2025

87505 Documentation and Support: Each facility shall document ...any reappraisal or assessment which was necessary...If supporting documentation from a physician is required, this input shall also be obtained and may be the same assessment... This requirement is not met as evidence by: Based on record review and interviews licensee did not ensure R1 was evaluated by a medical professional to determine level of care which poses a potential risk to the health, safety, or personal rights of the persons in care.the state’s words, verbatim · CDSS document, Apr 17, 2025

Plan of correction: Licensee will certify in writing that will ensure that a medical professional determines the need of level of care and will ensure that administrator obtains training on prohibited health conditions, higher level of care determination of care and submit a copy to the department by POC due date 4/24/25.

Allegation investigated: Staff did not reposition resident resulting in resident sustaining a stage 4 pressure injury.

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegation. LPA met with Claudia Almeida and explained the reason for the visit. The investigation consisted of the following: On 2/14/24 LPA Flores conducted a health and safety check visit at the facility and requested pertinent documents for resident #1(R1). On 2/26/24 LPA subpoena medical records for R1 from hospice services. On 7/29/24 LPA submitted a clinical consult. On 8/14/24 a follow up clinical consult was submitted to the department regarding the above allegation. On 8/30/24 LPA received clinical consult report. On 11/5/24 LPA Flores conducted a subsequent visit and delivered findings. The investigation revealed the following: Regarding allegation: Staff did not reposition resident resulting in resident sustaining a stage 4 pressure injury. It is alleged within six days of R1’s arrival to the facility a large and serious pressure ulcer developed. (CONTINUED ON LIC 9099C) Substantiated On 3/22/23 R1 was admitted to the facility, on the same day R1 initiated hospice care services. The same day, upon admission hospice nurse noted R1 exhibit Deep Tissue Injuries (DTI) and moisture associate with skin damage (MASD). On 3/29/23 additional DTIs were noted by hospice nurse. On 4/5/23 additional DTIs were observed by hospice nurse and wound care specialist was contacted. On 4/5/23 wound care specialist visited R1 and noted stage 3 and stage 4 wounds. Interviews conducted with staff revealed staff became aware R1 developed wounds. Staff were familiar with and instructed by hospice nurse to reposition R1 at least every two hours. Interviews with R1’s family members revealed, they had noticed that at the beginning it was difficult for the facility to provide care due to R1’s declined condition. However, family members felt that within a week facility staff was providing proper care and repositioning R1 as needed. Documents reviewed revealed R1 initiated hospice due to cognitive impairment, there are no other health conditions or health history noted. Hospice visits notes noted hospice nurse had provided training to facility staff and recommended R1 was reposition every two hours. Facility maintained a reposition log, per monthly reposition logs maintain between 3/29/23 to 4/5/23, R1 was reposition no more than between 1-3 times per day in a 24-hour period. Therefore, this allegation is substantiated. Based on LPAs interviews which were conducted and document records review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. ***An immediate Civil Penalty of $500.00 is being issued today, due to Resident #1 developing stage 3 and 4 wounds in a period of 7 days due to lack of repositioning as directed by hospice staff while in care. Refer to LIC 421IM*** The issuance of a civil penalty is being considered based on Health & Safety Code 1569.49 (f); if the department determines the injury of the resident is due to neglect. Exit interview was conducted with Claudia Almeida and a copy of this report, LIC 9099D, and appeal rights were provided. Hospice nurse noted R1 was observed with Deep Tissue Injuries and moisture associate by skin damage MASD by hospice nurse, upon initiating hospice on 3/22/23. Between 3/29/23 to 4/5/23 R1 developed stage 3 and stage 4 wounds which were noted by a wound specialist on 4/5/23. Interviews conducted with staff revealed R1 moved into the facility under hospice care services due to R1’s health condition and family’s wishes. Facility staff stated R1 was provided care by a hospice nurse and the facility’s staff for all activities of daily living. Per family members R1 had declined in health and needed more assistance. Documents reviewed revealed R1 was under hospice care prior to move into the facility. However, R1 was discharge from hospice on 3/20/23 due to R1 plateauing in health. R1 moved into the facility on 3/22/23 under a new hospice care service agency which provided care from 3/22/23 to 6/28/23. R1 passed away at the facility on 6/28/23 while a hospice care nurse was by R1’s side. Death certificate issued on 2/14/24 notes R1 passed away due to natural causes. Therefore, this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Regarding allegation: Staff did not change resident’s diaper in a timely manner. It is alleged caregivers were to check R1’s diaper every 2 hours day and night and staff did not do it. Interviews conducted with staff revealed, it is facility’s practice to change residents to check and change residents as needed. Staff stated R1 was being change at least every two hours or more often when necessary. Family members did not have concerns about the care that was being provided by the facility. Facility maintains a monthly diaper change log, per March and April 2023 logs resident was changed an average of 3-4 times in a 24 hour period. There is not enough evidence to say that R1 require changing more than the times noted on the logs reviewed. Therefore, the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with Claudia Almeida and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 5, 2024 · control 28-AS-20240213110519

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Nov 6, 2024

87468.2 Additional Personal Rights of Residents...: (a)... shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff... to meet their needs. This requirement is not met as evidence by: Based on interviews and document review conducted licensee failed to prevent R1 developed stage 3 and 4 wounds within 7 days of admission which poses an immediate health, safety, or personal rights risk to the persons in care.the state’s words, verbatim · CDSS document, Nov 5, 2024

Plan of correction: Administrator will provide staff with hospice, repositioning, wound prevention, observation, and care and submit a copy of training log with duration, topic, and sign-in log to the department by POC due date 11/6/24.

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 and explained the reason for the visit. The facility is licensed to served 6 residents, 60 years and over; of which 5 may be non-ambulatory and 1 bedridden with a hospice waiver for (6). Facility consist of a living room, a dining room, a kitchen, 4 resident bedrooms, 2 bathrooms, a laundry area, a backyard, and a garage. LPA conducted a tour of the facility with Gohar Armani and observed the following: Facility is clean and in good repair inside and outside. All ramps and passageway are clear of debris. Living room and dining room are properly furnish and required posting was observed. Kitchen was observed clean, and sufficient food supplies were observed for at least 2 days of perishables and 7 days of non-perishables. All cleaning supplies,medications, and sharps were observed locked in cabinets in kitchen/dining area. Laundry area was observed without hazardous. Each resident bedroom was observed with sufficient lighting, the required furniture and bedding supplies. Each bathroom was observed clean, with grab bars and skid mats. Water temperature was tested between 112.3 -116.8 degrees F., which is within the required 105-120 degrees F. Backyard has a covered patio with furniture. Carbon Monoxide/Smoke detectors were tested. Fire extinguisher was observed. LPA reviewed files for 5 residents and 5 staff. Administrator certificate #6043240740 was observed exp. date: 3/15/25. Interviews were conducted with 2 staff. Residents were not interview due to cognitive skills. Infection Control Plan and Emergency Disaster Plan were reviewed. Facility conducted a fire drill on 8/20/24 and are conducted quarterly. No Deficiencies were noted during this visit. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 22, 2024