Grant Serenity of Monrovia

Allegation investigated: Staff do not communicate effectively

**This report supersedes report dated 02/03/2026. The reason this report is being superseded is to make corrections to the number of staff that were interviewed. LPA interviewed an additional staff member over the phone. Additional information obtained was also included. The findings will remain the same.** Licensing Program Analysts (LPA) Daniel Konishi conducted an unannounced initial complaint visit to investigate the above allegations. LPA was allowed entry by Edwin Leonel, Caregiver and Araceli Sanches Alvarez, Caregiver and LPA explained the purpose of today's visit. The Administrator, Diana Castellanos arrived shortly after and LPA explained the purpose of the visit. On 02/03/2026, the initial investigation visit was conducted. The investigation consisted of the following: [Continue to LIC9099-C] Substantiated Facility submitted a copy of the resident roster and staff roster. LPA interviewed Administrator, Staff #2 (S2) to Staff #4 (S4), and Resident #1 (R1) to Resident #4 (R4) and Former Resident #1 (FR1). LPA was unable to interview Staff #1 (S1) due to language barrier. LPA reviewed and obtained documents from S1 to Staff #3 (S3’s) files that include: Staff Training and pertinent documents. LPA requested the monthly meal schedule and snack list. LPA toured the facility. LPA requested the Bed Repositioning Logs, Fire and Disaster Drill logs. On 02/06/2026, LPA spoke to the Administrator over the phone and obtained S4’s staff training documents. LPA also interviewed S4 over the phone. During today's visit, LPA obtained the following documents: staff and resident rosters. The investigation revealed the following: In regards to the allegation “Staff do not communicate effectively.” It is alleged that S1 and S2 cannot communicate with the residents at the facility because they do not speak English. LPA interviewed the Administrator and three (3) out of four (4) staff denied the allegation stating that the on-duty staff are able to communicate with the residents. LPA attempted to interview S1 but S1 was unable to communicate effectively or answer LPA’s questions due to the language barrier. Administrator stated that there is an on-call night shift supervisor and administrator available to speak with residents over the phone. However, these individuals are not physically present at the facility. However, per Administrator there are times when S1 is the only staff on-duty and not everyone living at the facility speaks S1’s language. This is a possible concern in case of an emergency there may be a language barrier between emergency medical personnel and S1 can have a language barrier. LPA interviewed one (1) out of four (4) residents that corroborated with the allegation stating that language barrier is a problem and sometimes there is one (1) staff at night that is unable to communicate with the resident in English. LPA interviewed an additional former resident that corroborated with the allegation stating that one (1) staff was unable to communicate in English. LPA interviewed three (3) out of four (4) residents that denied the allegation stating that the staff are able to communicate with the residents. There’s enough evidence to substantiate. Based on LPA interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. An exit interview was conducted with the Administrator, Diana Castellanos. A copy of the report and appeal rights were provided. Facility submitted a copy of the resident roster and staff roster. LPA interviewed Administrator, Staff #2 (S2) to Staff #4 (S4), and Resident #1 (R1) to Resident #4 (R4) and Former Resident #1 (FR1). LPA was unable to interview Staff #1 (S1) due to language barrier. LPA reviewed and obtained documents from S1 to Staff #3 (S3’s) files that include: Staff Training and pertinent documents. LPA requested the monthly meal schedule and snack list. LPA toured the facility. LPA requested the Bed Repositioning Logs, Fire and Disaster Drill logs. On 02/06/2026, LPA spoke to the Administrator over the phone and obtained S4’s staff training documents. LPA interviewed Staff #4 (S4) over the phone. During today's visit, LPA obtained the following documents: staff and resident rosters. The investigation revealed the following: In regards to the allegation: “Staff did not properly maintain floor surfaces.” It is alleged that the staff were more into cleaning than resident care and water was left on the floor during cleaning and not properly dried to prevent a fall risk. LPA interviewed the Administrator and three (3) out of four (4) staff that denied the allegation stating that they clean and properly dry the floor. LPA was unable to interview Staff #1 (S1) due to language barrier. LPA interviewed three (3) out of four (4) residents that denied the allegation stating that floors are kept clean, dry, and staff ensure that the residents are safe from falls after the floors are cleaned. LPA interviewed one (1) out of four (4) residents and one (1) former resident that corroborated with the allegation stating that the staff clean the floor often, which causes the floors to be kept wet and slippery and can cause a resident to fall. LPA toured the facility and observed the floors in the kitchen, dining room, hallways, resident bedrooms, and bathrooms were all clean, dry, and not wet nor slippery. There is not enough evidence to substantiate. Allegation: “Staff spoke inappropriately towards the residents.” It is alleged that the staff were not talking to the residents with dignity, respect and love. It is also alleged that the residents are afraid to report due to fear of retaliation. LPA interviewed the Administrator and three (3) out of four (4) staff that denied the allegation stating that all staff speak with residents with respect, dignity, and love and have not witnessed any other staff speak to residents without respect, dignity, and love. LPA was unable to interview Staff #1 (S1) due to language barrier. LPA interviewed one (1) out of four (4) residents and one (1) former resident that stated that there are some staff that speak to them in a frustrated and unfriendly tone but stated that there are some staff that treat them in a pleasant manner. LPA interviewed three (3) out of four (4) residents that denied the allegation stating that they are treated by staff with dignity, respect, and love and have not been mistreated by staff. There is not enough evidence to substantiate. Allegation: “Staff did not provide adequate care and supervision.” It is alleged that facility staff are not conducting checks on bed bound residents. The residents are left to help themselves and the current residents need skilled care to provide resources. The Administrator, three (3) out of four (4) staff interviewed denied the allegation. LPA was unable to interview Staff #1 (S1) due to language barrier. LPA interviewed three (3) out of four (4) residents interviewed denied the allegation stating that their cares are met. LPA interviewed one (1) out of (4) residents and one (1) former resident that denied the allegation but both stated the wait time to be helped by staff took a long time as there were times when the wait time was at least thirty minutes. LPA reviewed the Repositioning/Diaper Change log in January 2026 that their bed bound resident was repositioned/changed every two hours. Based on staff and record review and interview, there are two (2) caregivers on duty per shift and one caregiver on duty in the noc shift. All residents indicated that there are sufficient staff available to help provide care and supervision to meet their needs. LPA observed at the facility that the residents were being closely supervised by the care staff and that there were no immediate health or safety concerns. LPA interviewed two (2) residents that are non-ambulatory stating that they are checked daily by staff. LPA reviewed S1 to S4’s file that included staff training on Resident Care and Supervision conducted on May 2025 and Incontinence Care/Prevention of Skin Breakdown conducted in June 2025. Therefore, there was insufficient evidence to corroborate with the allegations. Allegation: “Staff did not provide adequate food service” and “Staff do not ensure a resident is being properly fed.” It is alleged that residents lost a lot of weight due to the food portions were not sufficient and the diets did not contain protein items. It is also alleged that the facility had to do Uber Eats to get enough food due to the staff not providing snacks in between meals. It is alleged that the residents are not allowed to put their food in the refrigerator due to the kitchen being "closed" for the night. LPA interviewed the Administrator and three (3) out of four (4) staff and they all denied the allegation. LPA was unable to interview Staff #1 (S1) due to language barrier. All staff interviewed indicated that all residents at the facility receive three meals and three snacks per day. All staff interviewed also indicated that facility provides a sufficient amount of food to all of the residents in care. LPA interviewed three (3) out of four (4) residents all claim they get enough food from the facility staff. LPA interviewed one (1) out of four (4) residents and one (1) former resident that corroborated with the allegation stating that they are not satisfied with the food served and that residents have lost weight due to lack of variety, alternate choices, and protein. LPA observed four (4) residents eating their meal at the dining hall during lunch time from 12:05pm to 12:30pm. LPA observed the kitchen and have sufficient supply of 2-day perishable & 7-day non-perishable food. [Continue to LIC9099-C] Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. LPA observed eating the following items: Empanadas, potato pie, avocadoes, Jello, and beverage. Residents were in a pleasant mood while continuing to eat lunch. LPA observed no concerns regarding residents not getting enough food from the facility. LPA reviewed S1 to S3’s file that included staff training on Cultural Competency and Sensitivity conducted on September 2025. LPA reviewed S4’s file that included staff training on Cultural Competency and Sensitivity conducted on January 2025. There is not enough sufficient evidence to substantiate. Allegation: “Staff did not provide adequate lighting for the residents.” It is alleged that the home has no lights in the hallway and the staff would not assist when residents needed to get up at night to use the bathroom. LPA interviewed Administrator and three (3) out of four (4) staff that denied the allegation stating that adequate lighting is provided and they assist residents at night to use the restroom. LPA was unable to interview Staff #1 (S1) due to language barrier. LPA interviewed one (1) out of four (4) residents and one (1) former resident corroborated with the allegation stating that the hallway lights are not turned on at night by staff when residents need to go to the restroom. LPA interviewed three (3) out of four (4) residents that denied the allegation stating that there is adequate lighting all day and night so that staff can help provide assistance for residents to go to the restroom. LPA observed that hallway lights are on. Per Administrator, the hallway lights are on at night to assist residents to go to the restroom. There is not enough sufficient evidence to substantiate. Allegation: “Staff do not follow proper fire safety measures.” It is alleged that the facility does not have any fire extinguishers. LPA interviewed the Administrator, three (3) out of four (4) staff that denied the allegation stating that they are properly trained and conducted in fire drills. LPA was unable to interview Staff #1 (S1) due to language barrier. LPA interviewed one (1) out of four (4) residents that denied the allegation stating that the facility does have fire extinguishers in the facility. LPA interviewed three (3) out of four (4) residents who can confirm nor deny the allegation not knowing if the facility conducts fire safety procedures. LPA also observed two (2) fire extinguishers that are fully charged and last inspected on 09/04/2025. Carbon Monoxide detectors were tested and are operating properly. LPA reviewed prior Fire and Disaster drill logs and the Last Fire Drill was conducted on 11/12/2025. The Last Disaster Drill was conducted on 11/12/2025. LPA reviewed S1 to S3’s file that included staff training on Building and Fire Safety and Appropriate Emergencies Response conducted in October 2025. LPA reviewed S4’s file that included staff training on Building and Fire Safety and Appropriate Emergencies Response conducted in January 2025. There is not enough evidence to substantiate. Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegation. 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 allegations are UNSUBSTANTIATED. Exit interview was held, and a copy of this report was provided to the Administrator, Diana Castellanos.the state’s words, verbatim · CDSS document, Feb 10, 2026 · control 28-AS-20260127104821

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87411(d)(3) · Plan of correction due date: Feb 24, 2026

87411(d)(3) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: (3) Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement is not met as evidenced by: Based on observation and interview, facility is not in compliance as LPA attempted to interview Staff #1 (S1) but S1 was unable to communicate effectively due to a language barrier. Per Administrator, there are times when S1 is the only staff on-duty at the facility. Not everyone living at the facility speaks S1’s language. In case of emergencies, S1 might be unable to communicate with medical personnel due to a language barrier. This poses an potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 10, 2026

Plan of correction: Facility will ensure that there shall be at least one person capable of and responsible for communicating with emergency personnel in the facility at all times. Facility to submit written plan indicating how they will ensure that this regulation is met to the LPA by the POC due date.

Allegation investigated: Staff do not communicate effectively

Licensing Program Analysts (LPA) Daniel Konishi conducted an unannounced initial complaint visit to investigate the above allegation(s). LPA was allowed entry by Edwin Leonel, Caregiver and Araceli Sanches Alvarez, Caregiver and LPA explained the purpose of today's visit. Administrator, Diana Castellanos arrived shortly after and LPA explained the purpose of the visit. Investigation consisted of: Facility submitted a copy of the resident roster and staff roster. LPA interviewed Administrator, Staff #1 (S1) to Staff #3 (S3), and Resident #1 (R1) to Resident #4 (R4) and Former Resident #1 (FR1). LPA reviewed and obtained documents from S1 to Staff #3 (S3’s) files that include: Staff Training and pertinent documents. LPA requested the monthly meal schedule and snack list. LPA toured the facility. LPA requested the Bed Repositioning Logs, Fire and Disaster Drill logs. LPA observed the kitchen and have sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. LPA also observed residents during the mealtime at lunch from 12:05pm 12:30pm. Substantiated The investigation revealed the following: In regards to the allegation “Staff do not communicate effectively.” It is alleged that S1 and S2 cannot communicate with the residents at the facility because they do not speak English. LPA interviewed the Administrator and two (2) out of three (3) staff denied the allegation stating that the on-duty staff are able to communicate with the residents. LPA attempted to interview S1 but S1 was unable to communicate effectively or answer LPA’s questions due to the language barrier. Administrator stated that there is an on-call night shift supervisor and administrator available to speak with residents over the phone. However, these individuals are not physically present at the facility. However, per Administrator there are times when S1 is the only staff on-duty and not everyone living at the facility speaks S1’s language. This is a possible concern in case of an emergency there may be a language barrier between emergency medical personnel and S1 can have a language barrier. LPA interviewed one (1) out of four (4) residents that corroborated with the allegation stating that language barrier is a problem and sometimes there is one (1) staff at night that is unable to communicate with the resident in English. LPA interviewed an additional former resident that corroborated with the allegation stating that one (1) staff was unable to communicate in English. LPA interviewed three (3) out of four (4) residents that denied the allegation stating that the staff are able to communicate with the residents. There’s enough evidence to substantiate. Based on LPA interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. An exit interview was conducted with the Administrator, Diana Castellanos. A copy of the report and appeal rights were provided. The investigation revealed the following: In regards to the allegation: “Staff did not properly maintain floor surfaces.” It is alleged that the staff were more into cleaning than resident care and water was left on the floor during cleaning and not properly dried to prevent a fall risk. LPA interviewed the Administrator and three (3) out of three (3) staff that denied the allegation stating that the clean and properly dry the floor. LPA interviewed three (3) out of four (4) residents that denied the allegation stating that floors are kept clean, dry, and staff ensure that the residents are safe from falls after the floors are cleaned. LPA interviewed one (1) out of four (4) residents and one (1) former resident that corroborated with the allegation stating that the staff clean the floor more often that the floors are kept wet and slippery. LPA toured the facility and observed the floors in the kitchen, dining room, hallways, resident bedrooms, and bathrooms were all clean, dry, and not wet nor slippery. There is not enough evidence to substantiate. Allegation: “Staff spoke inappropriately towards the residents.” It is alleged that the staff were not talking to the residents with dignity, respect and love. It is also alleged that the residents are afraid to report due to fear of retaliation. LPA interviewed the Administrator and three (3) out of three (3) staff that denied the allegation stating that all staff speak with residents with respect, dignity, and love and have not witnessed any other staff speak to residents without respect, dignity, and love. LPA interviewed one (1) out of four (4) residents and one (1) former resident that stated that there are some staff that speak to them in a frustrated and unfriendly tone but stated that there are some staff that treat them in a pleasant manner. LPA interviewed three (3) out of four (4) residents that denied the allegation stating that they are treated by staff with dignity, respect, and love and have not been mistreated by staff. There is not enough evidence to substantiate. Allegation: “Staff did not provide adequate care and supervision.” It is alleged that facility staff are not conducting checks on bed bound residents. The residents are left to help themselves and the current residents need skilled care to provide resources. The Administrator, three (3) out of three (3) staff interviewed denied the allegation. LPA interviewed three (3) out of four (4) residents interviewed denied the allegation stating that their cares are met. LPA reviewed the Repositioning/Diaper Change log in January 2026 that their bed bound resident was repositioned/changed every two hours. Based on staff and record review and interview, there are two (2) caregivers on duty per shift. All residents indicated that there are sufficient staff available to help provide care and supervision to meet their needs. LPA observed at the facility that the residents were being closely supervised by the care staff and that there were no immediate health or safety concerns. LPA interviewed two (2) residents that are bedbound stating that they are checked daily by staff. LPA reviewed S1 to S3’s file that included staff training on Resident Care and Supervision conducted on May 2025 and Incontinence Care/Prevention of Skin Breakdown conducted in June 2025. Therefore, there was insufficient evidence to corroborate with the allegations. Allegation: “Staff did not provide adequate food service” and “Staff do not ensure a resident is being properly fed.” It is alleged that residents lost a lot of weight due to the food portions were not sufficient and the diets did not contain protein items. It is also alleged that the facility had to do Uber Eats to get enough food due to the staff not providing snacks in between meals. It is alleged that the residents are not allowed to put their food in the refrigerator due to the kitchen being "closed" for the night. LPA interviewed the Administrator and three (3) out of three (3) staff and they all denied the allegation. All staff interviewed indicated that all residents at the facility receive three meals and three snacks per day. All staff interviewed also indicated that facility provides a sufficient amount of food to all of the residents in care. LPA interviewed three (3) out of four (4) residents all claim they get enough food from the facility staff. LPA interviewed one (1) out of four (4) residents and one (1) former resident that corroborated with the allegation stating that they are not satisfied with the food served and that residents have lost weight due to lack of variety, alternate choices, and protein. LPA observed four (4) residents eating their meal at the dining hall during lunch time from 12:05pm to 12:30pm. LPA observed eating the following items: Empanadas, potato pie, avocadoes, Jello, and beverage. Residents were in a pleasant mood while continuing to eat lunch. LPA observed no concerns regarding residents not getting enough food from the facility. LPA reviewed S1 to S3’s file that included staff training on Cultural Competency and Sensitivity conducted on September 2025. There is not enough sufficient evidence to substantiate. Allegation: “Staff did not provide adequate lighting for the residents.” It is alleged that the home has no lights in the hallway and the staff would not assist when residents needed to get up at night to use the bathroom. LPA interviewed Administrator and three (3) out of three (3) staff that denied the allegation stating that adequate lighting is provided and they assist residents at night to use the restroom. LPA interviewed one (1) out of four (4) residents and one (1) former resident corroborated with the allegation stating that the hallway lights are not turned on at night by staff when residents need to go to the restroom. LPA interviewed three (3) out of four (4) residents that denied the allegation stating that there is adequate lighting all day and night so that staff can help provide assistance for residents to go to the restroom. LPA observed that hallway lights are on and per Administrator that they are on at night to assist residents to go to the restroom. There is not enough sufficient evidence to substantiate. Allegation: “Staff do not follow proper fire safety measures.” It is alleged that the facility does not have any fire extinguishers. LPA interviewed the Administrator, three (3) out of three (3) staff that denied the allegation stating that they are properly trained and conducted in fire drills. LPA interviewed one (1) out of four (4) residents that denied the allegation stating that the facility does have fire extinguishers in the facility. LPA interviewed three (3) out of four (4) residents who cannot confirm nor deny the allegation not knowing if the facility conducts fire safety procedures. LPA also observed two (2) fire extinguishers that are fully charged and last inspected on 09/04/2025. Carbon Monoxide detectors were tested and are operating properly. LPA reviewed prior Fire and Disaster drill logs and the Last Fire Drill was conducted on 11/12/2025. The Last Disaster Drill was conducted on 11/12/2025. LPA reviewed S1 to S3’s file that included staff training on Building and Fire Safety and Appropriate Emergencies Response conducted in October 2025. There is not enough evidence to substantiate. Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegation. 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 allegations are UNSUBSTANTIATED. Exit interview was held, and a copy of this report was provided to the Administrator, Diana Castellanos.the state’s words, verbatim · CDSS document, Feb 3, 2026 · control 28-AS-20260127104821

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(d)(3) · Plan of correction due date: Feb 17, 2026

87411(d)(3) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: (3) Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement is not met as evidenced by: Based on observation and interview, facility is not in compliance as LPA attempted to interview Staff #1 (S1) but S1 was unable to communicate effectively due to a language barrier. Per Administrator, there are times when S1 is the only staff on-duty at the facility. Not everyone living at the facility speaks S1’s language. In case of emergencies, S1 might be unable to communicate with medical personnel due to a language barrier. This poses an potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: Facility will ensure that there shall be at least one person capable of and responsible for communicating with emergency personnel in the facility at all times. Facility to submit written plan indicating how they will ensure that this regulation is met to the LPA by the POC due date.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Daniel Konishi conducted the required unannounced annual inspection. LPA was allowed entry by Araceli Sanches Alvarez, Caregiver and LPA explained the purpose of today's visit. Co-Administrator, Natalia Arpentieva arrived shortly after and assisted LPA with the inspection. The facility is licensed to serve six (6) non-ambulatory residents ages 60 and over, of which one (1) may be bedridden. All bedrooms approved for bedridden. Waiver granted for two (2) hospice care. The initial annual visit was conducted on 12/02/2025. During the initial visit the following ten (10) Compliance and Regulatory Enforcement (CARE) tool Licensee, Natalia Arpentieva.domains were observed and reviewed: Infection Control, Operational Requirement, Physical Plant/ Environmental Safety, Resident Rights-Information, Staffing, Personnel Records-Training, Planned Activities, Food Service, Incidental Medical and Dental, Disaster Preparedness. During today’s annual visit, the following two (2) Compliance and Regulatory Enforcement (CARE) tool domains were observed and reviewed: Resident Records-Personnel Reports, Resident with Special Health Needs. Resident Records-Incident Reports: LPA reviewed five (5) resident files containing Information and Emergency Identification, Admission Agreements, Physician's Report, TB clearance, Ambulatory Status, Medical/Functional assessments, Pre-Placement Appraisal, Appraisal/Needs and Services Plans, Personal Rights, Restricted Health Care Plans and Hospice Notes/Records were reviewed. [Continue in LIC809-C] Resident with Special Health Needs: One (1) resident receive hospice care. Appraisals were observed in resident files. No residents have prohibited health conditions. LPA reviewed physician orders for use of full bed rails in (1) resident file who is under hospice care. LPA reviewed physician orders for three (3) residents that use bed rails. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview and a copy of this report were provided to Co-Administrator, Natalia Arpentieva.the state’s words, verbatim · CDSS document, Dec 4, 2025

Allegation investigated: Resident sustained injury due to staff neglect.

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Staff S1 and explained the reason for the visit. The purpose of the visit is to conduct a 10 day complaint visit in regards to the above allegation. Shortly thereafter Assistant Administrator Diana Castellanos arrived. At today's visit 12/02/25 the following was done: Staff S1- Staff S4 were interviewed. S3 and S4 were interviewed telephonically. Assistant Administrator Diana Castellanos was interviewed. Resident's R2-R5 were interviewed. Attempts to interview Resident R6 were unsuccessful as R6 was unable to respond to questions being non-verbal. Private Caregiver for Resident R1 was interviewed. Hospice Nurse for Resident R1 was interviewed. File of Resident R1 was reviewed and Physician's Report, Admissions Agreement and Emergency Face Sheet to be submitted. Resident and Staff Roster submitted. Unsubstantiated In regards to the allegation Resident sustained injury due to staff neglect, based on interviews conducted and information gathered it was revealed by the Hospice Nurse that signs of abuse were not observed. Said there were no bruises from a fall and no bleeding. Interview with Resident R2- R5 who stated that staff treats them well and they assist with food, medication and hygiene. Have not had any issues with neglect and that they were unaware of Resident R1's alleged incident. Primary Caregiver stated that Resident R1's mouth was cleaned inn the bathroom and had all teeth after that. Not sure what occurred, but said Resident R1 has gum disease and it could be old and decaying and R1 lost it. Assistant Administrator stated that R1 had own private caregiver till R1 was comfortable at the facility. Stated that the private caregiver brushed R1's teeth and was at the facility for most of R1's stay and said private caregiver didn't notice anything. Staff S1- S4 all stated that R1's private caregiver was with R1 and brushed R1's teeth and took care of R1's feedings. All stated they did not observe any neglect of R1 or any resident and said they treat all residents well. 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. Exit interview conducted with Assistant Administrator Diana Castellanos and report issued.the state’s words, verbatim · CDSS document, Dec 2, 2025 · control 28-AS-20251124142014

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Daniel Konishi conducted the required annual inspection. LPA was allowed entry by Edwin Leonel, Caregiver and Araceli Sanches Alvarez, Caregiver and LPA explained the purpose of today's visit. Administrator Diana Castellanos arrived shortly after and assisted LPA with the inspection. On today's date, LPA inspected the ten (10) domains include: Infection Control, Operational Requirement, Physical Plant/Environmental Safety, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Planned Activities, Food Services, Incidental Medical and Dental, Disaster Preparedness. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has an Infection Control Plan in place. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff are adhering to infection control requirements. Physical Plant/Environment Safety: The facility is a single-story home located in a residential neighborhood that is licensed to serve 6 non-ambulatory residents ages 60 and over, of which (1) may be bedridden. Waiver granted for (2) hospice care. Current census is six (6) of which one (1) is under hospice care. Home consists of six (6)resident bedrooms, 2 bathrooms, living room, dining room, kitchen, backyard, and a detached garage being used as a staff rest area. The interior and exterior physical plant was inspected. LPA inspected residents’ rooms and each resident bedroom has the required furniture such as bed frames, dressers, nightstand, lamps, and chairs. Bedrooms also have sufficient closet space. Extra linens and towels are in each resident's bedroom closet. Physical Plant/Environment Safety [Cont.]: Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and Carbon monoxide detectors were tested and are operational. The facility has (2) fire extinguishers in the facility which were last serviced on 09/04/2025. There are cameras in the common areas. Cleaning supplies and toxic substances are locked and inaccessible to clients. The hot water temperature readings measured 116.7 deg F in bathroom #1 and 114.9 deg F in bathroom #2 which are within the required 105-120 degrees Fahrenheit. Operational Requirements: A fire clearance is in place. Valid Liability Insurance policy is in place. The Last Fire Drill was conducted on 11/12/2025. The Last Disaster Drill was conducted on 11/12/2025. Care and supervision to meet the residents’ needs was observed. Special equipment and supplies to meet the persons with special needs were observed. Staffing: A total of nine (9) caregivers including the (2) Administrators provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and are associated to the facility. Personnel Records-Training: LPA reviewed Four (4) staff files which include Personnel record, health screening, TB clearance, Employee Rights, and First Aid/CPR training. Administrator’s Certificate Expires on 01/06/2027. Resident Rights-Information: Resident personal rights are posted. Residents have access to internet and the telephone. Planned Activities: There is sufficient space to accommodate both indoor and outdoor activities. Information regarding Dementia is part of the training for direct care staff and is included in the Plan of Operation. Food Service: The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Incident Medical and Dental: Medication are centrally stored in a locked cabinet next to the kitchen area. LPA reviewed five (5) residents’ medications. Medications are given as prescribed. First Aid Kit was inspected and has all required items. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least two (2) relocation sites. Facility maintains documentation of the required emergency drills. The Last Fire Drill was conducted on 11/12/2025. The Last Disaster Drill was conducted on 11/12/2025. ***Due to time constraints, LPA was not able to complete the annual inspection for this facility. LPA will do a continuation of this inspection at a later date.*** Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview and a copy of this report were provided to Administrator, Diana Castellanos.the state’s words, verbatim · CDSS document, Dec 2, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted the required annual inspection. LPA was allowed entry by Victoria Mejia, Caregiver and explained the purpose of today's visit. Administrators Nvard Gevorkianand Diana Castellanos arrived shortly after and assisted LPA with the inspection. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor screening station at the entrance of the facility. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan and was reviewed. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff are adhering to infection control requirements. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood that is licensed to serve 6 non-ambulatory residents ages 60 and over, of which (1) may be bedridden. Waiver granted for (2) hospice care. Current census is six (6) of which one (1) is under hospice care. Home consists of six (6)resident bedrooms, 2 bathrooms, living room, dining room, kitchen, backyard, and a detached garage being used as a staff rest area. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors are operational. The facility has (2) fire extinguishers in the facility which were last serviced on 10/08/2024. There are cameras in the common areas. Cleaning supplies and toxic substances are inaccessible to clients. At 10:20am, hot water temperature readings measured 116.9 deg F in bathroom #1 and 109.2 deg F in bathroom #2 which are within the required 105-120 degrees Fahrenheit. Operational Requirements: Infection Control and Dementia plans have been added to the Plan of Operation. A fire clearance is in place. Liability Insurance policy is valid and will expire on 05/17/2025. The last fire Drill was conducted on 09/17/20243. Care and supervision to meet the residents needs was observed. Special equipment and supplies to meet the persons with special needs were observed. ***CONTINUED ON LIC 809-C** Staffing: A total of nine (9) caregivers including the (2) Administrators provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and associated to the facility. Personnel Records-Training: Administrator certificate is valid and expires on 12/23/2024, renewal has been submitted in September 2024. Four (4) staff files were reviewed for criminal background clearance and training. Personnel records have health/TB screenings and First Aid/CPR training. Resident Records-Incident Reports: Six (6) resident files were reviewed containing admission agreements, Physician's Report, Medical/Functional assessments, Needs and Services Plans, TB clearance, Personal rights, Medical Consent, Medication Records, Restricted Health Care Plans and Hospice Notes/Records were reviewed. Resident Rights-Information: Resident personal rights are posted. Physician orders for use of full bed rails were reviewed in (1) resident file who is under hospice care. Four (4) other residents use 1/2 bed rail with physician orders, but one (1) resident did not have the order on file. Planned Activities: There is sufficient space to accommodate both indoor and outdoor activities. Information regarding Dementia is part of the training for direct care staff and is included in the Plan of Operation. Food Service: The kitchen was inspected and has sufficient supply of 2-day perishable & 7 day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Medications reviewed for all (6) residents. Incident Medical and Dental: All residents have Restricted Health Care Plan and Needs and Services Plan on file. Currently, (4) residents receive Home Health care in the facility. Residents medication are centrally stored in a locked cabinet next to the kitchen area. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. The facility conducts emergency drill on a quarterly basis. Residents with SHN: One (1) resident receive hospice care. Appraisals were observed in resident files. No residents have prohibited health conditions. Deficiencies cited, exit interview conducted and a copy of the report along with the appeal rights were provided to the Administrator, Diana Castellanos.the state’s words, verbatim · CDSS document, Dec 20, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Tena Herrera conducted an announced visit and met with Administrator Nvard Gevorkian for the purpose of conducting an Initial Pre-Licensing Inspection / Component III visit. The facility has an approved fire clearance to be licensed to serve 6 Non-Ambulatory Residents, of which 1 may be bedridden. All bedrooms are approved for bedridden. Facility is a single-story home located in Monrovia, Ca and includes the following: 6 Bedrooms, 2 full bathrooms (one located in garage and will be used by staff only), 1 half-bathroom, living room, kitchen, dining area, 3 locked outdoor storage areas, detached garage, and a back yard with shaded outdoor patio area. LPA toured facility inside and out alongside Administrator Nvard Gevorkian, The Pre-Licensing Inspection Tool was utilized and the following was observed: There is a locked cabinet that is centrally located for medication within the kitchen area of the facility. Cleaning supplies are kept separate from food and located in a locked cabinet under the kitchen sink. Facility walls, ceilings, floors, window screens and areas around the facility are clean and in good repair. Fire extinguishers and smoke detectors operate properly. Doors and passageways are free of obstruction. There are no pools/bodies of water at the facility. Facility does not have firearms on premises. Facility sketch and sample menus were posted and visible within the facility. (Continued on 809-C) There is an emergency exiting plan with emergency phone numbers posted and visible within the facility. Facility has a current disaster and mass casualty plan maintained. There is a plan for employee accommodations and staffing arrangements. Operating telephone and internet is on the premises and will be available to clients. The facility does not currently have clients nor staff therefore only the Administrators file was reviewed. First-aid supplies are maintained and readily available. Refrigerator and freezer were observed and are maintained at the correct temperatures. Food storage and preparation are clean and appropriate for food preparation. Hot water temperature was tested and is within the required range of 105-120 degrees F. Facility has the required posters in the facility including Personal Rights, Rights of Resident Council, Complaint Poster and Visiting Policy. Facility currently does not have the required liability insurance, as insurance company needs a copy of the license before issuing needed insurance, Administrator Nvard Gevorkian confirmed that a copy of the liability insurance will be provided to LPA once license is issued and prior to admitting residents. Component III was denied at this time as Administrator has 8 other licensed facilities and is familiar with all information within Component III. An exit interview was conducted, and a copy of this report has been furnished to Administrator Nvard Gevorkian. LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, Dec 1, 2023

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Nvard Gevorkian Interview Method: Telephone interview On November 21, 2023, applicant/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 the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Nov 21, 2023