Grant Serenity of Verdugo

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nadia Shahbazian conducted an Annual Required visit and inspection of the facility. LPA met with Administrator Diana Castellanos and explained the reason for the visit. Facility is licensed to serve 6 non-ambulatory residents over the age of 60, of which (3) may be bedridden, with a hospice waiver for (2). Current census is 5 residents, (1) of which is receiving hospice services. Facility has a valid Certificate of Liability Insurance, with expiration date of 05/20/2026. At 9:45am, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The auditory alarms on all exit doors were installed and functional at the time of the visit. The smoke/carbon monoxide detectors are hardwired and interconnected. At 10:10 am the smoke/carbon monoxide detectors were tested and observed to function properly. The are two fire extinguishers, one in the laundry room and one in the hallway. Both fire extinguishers are full with a charge date of 04/27/2025. Facility conducts quarterly emergency drills. The last fire and earthquake drill was conducted together on 07/07/2025. Facility uses the front entry door as the main exit. There is an additional exit door on the hallway next to bedroom #1 and another exit door in the laundry room. There is a side gate, in the front, for emergencies as well. Kitchen: The kitchen appliances include a refrigerator, stove/oven and microwave; all fixtures were functional. LPA found a sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility. Knives were stored in a locked drawer in the kitchen and detergents/chemicals were stored locked, underneath the sink. All kitchen surfaces and cabinets were observed to be clean and sanitary. Common Areas: These included the living room and dining area. The living room was furnished with sofas, a television set and a cabinet for storage of games. Dining room was furnished with a dining table and six chairs, appropriate for number of residents. Continued on 809-C Bedrooms: There are five (5) bedrooms designated for residents' use. Bedroom #1 and #2 are designated for bedridden residens. All bedrooms are were properly furnished with appropriate beddings, chairs, cabinets, linens and have sufficient lighting. Bathrooms: There are two (2) bathrooms, one for staff use and one for residents' use. LPA observed functional fixtures, grab bars and non-skid mats in each bathroom. Hot water temperature in resident bathroom was measured at 115.4 degrees Fahrenheit. Surrounding Grounds: There were no pool but there is a tall water fountain, against the back wall of the backyard. Surrounding areas were clean, sanitrary and clear of obstructions. There is a covered patio with furniture appropriate for outdoor use. There is a side gate for emergencies and there is a detached garage, currently used as storage. LPA observed a refrigerator, with supply of perishable foods in the garage. Facility has a power generator and is equipped with visual cameras throughout the front yard, back yard and common areas. In addition facility has internet, cable and telephone lines for resident's use. Laundry Room: The laundry room is located near the kitchen and has an exit door, leading to the backyard. Both washer and dryers are functional; the chemicals and detergents are kept locked in cabinets. In addition there is a cabinet for emergency food and a supply of non-perishable food items. LPA observed three cans of vegetables with expiration date of 05/07/2025. Administrator immediately removed and trashed the cans. A citation will be issued for the expired food supply. Resident Files/Medications: Resident files for all five residents were reviewed to ensure compliance with required documentation. Medications for 3 out of 5 residents for counted for accuracy of administration. Office Area: Office is located near bedroom #1. LPA observed resident and staff files locked in the office area. The medications were kept locked in cabinets and in a locked refrigerator in the office. A complete first aid kit and the first aid manual were also kept in the office. Staff Files: LPA also conducted a file review of records for 4 staff, to insure forms and training are up to date and in compliance with licensing requirements. Deficiency cited and cleared during today’s visit. Appeal rights issued and given. Exit interview conducted and copy of this report was provided to the administrator.the state’s words, verbatim · CDSS document, Aug 29, 2025

Type of visit: Required - 1 Year

On 09/27/24, 9:35AM, Licensing Program Analyst (LPA) Raymond Comer arrived to conduct an unannounced annual visit of the Facility. LPA met with caregiver staff, who contacted Facility Administrator, Nvard Gevorkian, via cell phone. LPA spoke with the Administrator, and the reason for the visit was stated. At around 10:00AM, Administrator Designee, Ani Karapetyan, arrived at the facility to assist with LPA's inspection. Facility is licensed as a single-story residence, fire clearance for six (6) non-ambulatory, and three (3) bedridden. Hospice Waiver Approved for two (2). Facility has four (4) private bedrooms, one (1) shared bedroom, and two (2) bathrooms. At 10:15AM, LPA conducted a tour of the physical plant with the Administrator Designee and observed the following: Physical plant was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access. Second exit point is located in rear area of facility, adjacent to bedroom#1. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Hand washing, coughing etiquette, and other signage are posted in the bathrooms, and throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 72.0°F. within the required range. Required postings are prominently displayed and observed to be current. Disaster drills were last conducted on June 2024. Fire Detection system is present in the facility. Dual smoke/carbon monoxide detectors are located in bedrooms, and throughout the facility. Smoke and Carbon monoxide detectors were tested and function properly. LPA observed fire extinguisher hanging in the hallway, near the dining room. Purchase/Service Date: 09/27/2024. [LIC 809-C] Continued Kitchen: At 11:00AM, LPA observed kitchen as clean, equipped with a functional stove, multiple appliances, with adequate supply of perishables and non-perishable food. Emergency food is stored and locked in laundry room area cabinet. Food is observed as properly labeled and stored. Kitchen cabinets store dishes, plastic, paper goods and utensils. Knives and sharps are stored and locked in kitchen drawer, and inaccessible to residents. Medications were observed as stored in office room located between the living room and restroom. Medication area is locked and inaccessible to residents. Facility has fully stocked first aid kit and manual located and in the medication cabinet. Medications are listed on a centrally stored medication and destruction record log. Laundry: LPA observed the laundry room located next to the kitchen. Laundry machines, soaps, and other cleaning agents are secured and inaccessible for residents. Linen storage observed to have adequate supply of linen and towels. Garage: Garage is detached from the Facility. LPA observed garage as secured and inaccessible for residents. Garage is a equipped with multiple tier shelving units stocked with non-perishable food, can goods, dry cereals, snacks, emergency food, personal care items, incontinent supplies, paper towels, tissue, cleaning products, water, and PPE. Garage is equipped with a refrigerator storing, meats, vegetables, and fruit. Extra linen, towels, comforters PPE, and various other supplies. Commons: LPA observed all common areas of the facility, including the resident dining area. LPA observed common areas to be clean, organized, properly furnished and in good condition. Furniture in common area was observed to be in good repair. Bedrooms are observed as clean with sufficient lighting, properly furnished with bedding, linens, at least one chair, and night stand. Bathrooms were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 108.5°F. Within the required range. [LIC 809-C]-continued Outdoor (backyard) area observed to have a shaded patio, with table and sufficient seating for the residents. Outdoor furniture observed to be in good condition. All trash cans were observed to be covered. Outdoor area observed as clean and clear from obstruction. No bodies of water are located on the premises. Resident records: All Resident's files were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. Resident records appeared to be complete and current. Staff records: All Staff files were reviewed. Criminal record clearances were present and Staff are associated to this facility. Staff records appear to be complete and current. There were no immediate health and safety hazards observed at the time of this inspection. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 27, 2024

Allegation investigated: Resident was sexually abused

Licensing Program Analyst (LPA) Antonia Alvizar conducted a subsequent complaint investigation visit to the facility. LPA met with House Manager, Ruzanna Sukiassyan and granted entry. House Manager contacted via phone Administrator, Nvard Gevorkian and later joined us. The purpose of the visit was discussed. It was reported that resident #1 (R1) has bruising, redness and pain in their private area that could have been resulted from possible sexual abuse. (Administrator provided photographic evidence) During the initial investigation on 10/25/2023 between 2:45p.m. – 3:30p.m. LPA Antonia Alvizar initiated staff interviews. Interviews revealed that staff did not know anything about a resident being sexually abused. Staff also revealed that R1 always scratches their private parts. R1 had a stroke and has limited functions on the left side. To prevent R1 from scratching their private parts, staff put on a glove on their right hand. At the time of initial visit R1 was at the hospital. On 10/25/23 while LPA was exiting the facility R1’s family member arrived to the facility, due to R1’s Unsubstantiated discharge from the hospital. LPA Alvizar interviewed R1’s family member, who confirmed that R1 scratches vaginal area causing redness and bruises. A family member indicated that has no concerns about R1 being sexually abused and staff does a great job caring for R1. A family member also confirm that R1 is taking over the counter Benadryl as needed for itching. On 11/30/2023 at 7:45p.m., LPA Alvizar reviewed R1’s physician’s report. Records revealed that R1 has secondary health condition causing dry skin. Records also revealed that R1 has a history of skin condition that causes itching. R1 has a prescription of Benadryl 25MG as needed. Based on interviews and record review, there is not sufficient information to support this allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No immediate health and safety hazard is noted during this visit. Exit interview conducted and copy of report was issued Administrator, Gevorkian.the state’s words, verbatim · CDSS document, Dec 1, 2023 · control 31-AS-20231024151628

Type of visit: Case Management - Other

Licensing Program Analyst(LPA) Antonia Alvizar met with the Administrator, Nvard Gevorkian and made a subsequent complaint #31-AS-20231024151628 visit to this facility. This Case Management has nothing to do with complaint visit. During Complaint Investigation, LPA Alvizar discovered the following Part-Time Staff (S1) and (S2) have been present without a Criminal Background Clearance or Transfer and Association to this facility. S1 job title is House Manager, first day of work was 10/01/2023. S2 job title is Cleaner and today was the first day at work. LPA request/received S1 California Driver License. LPA request S2 identification, S2 indicated that did not have any identification on her at the time of this visit. S2 provided LPA with date of birth, first and last name. Administrator confirm that was S2 identification information. Administrator indicated that S2 is contracted by Maybins Cleaning agency. LPA verified using Guardian Background System Check, staff S1 and S2 names did not appeared on facility roster. S1- Ruzanna Sukiassyan DOB: 02/21/1961 S2 - Alex Garcia DOB: 02/25/1986 A citation and civil penalty were issued. Copy of this report was provide to Administrator, Gevorkianthe state’s words, verbatim · CDSS document, Dec 1, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(b)(2) · Plan of correction due date: Dec 1, 2023

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working... in a licensed facility: (2)Request a transfer of a criminal record clearance as specified in Section 87355(c)... This requirement is not met as evidence by: Based on interview and review of Guardian Background System staff S1&S2 are not Criminal Background Clearanced or Transfer & Associated to this facility. No documentation has been submitted to CCLD. This poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Dec 1, 2023

Plan of correction: Administrator has completed Criminal Background Clearance or Transfer & Associated S1 to facility. Administrator provided documentation to LPA dated 12/01/2023. POC has been cleared during today's visit. S2 exit the facility with administrator and will not return.

Type of visit: Case Management - Other

Licensing Program Analyst(LPA) Antonia Alvizar met with the Administrator, Nvard Gevorkian and made an initial complaint #31-AS-20231024151628 visit to this facility. This Case Management has nothing to do with complaint visit. During Complaint Investigation, LPA Alvizar discovered the following Full-time Staff (S1) and (S2) have been present without a Criminal Background Clearance and Association to this facility. S1 and S2 are married and stated their first day of work was 09/10/2023. LPA request/received staff S1 and S2 California Identification Card. LPA verified using Guardian Background System Check, staff S1 and S2 names did not appeared on facility roster. S1- Vera Romanova DOB: 11/07/1997 S2- Nikolai Romanov DOB: 05/02/1989 S1 and S2 were asked to leave the facility and do not return until Criminal Background Clearance and Associated to this facility. A citation and civil penalty were issued. Copy of this report was provide to Administrator Gevorkianthe state’s words, verbatim · CDSS document, Oct 25, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(b)(2) · Plan of correction due date: Oct 26, 2023

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working... in a licensed facility: (2)Request a transfer of a criminal record clearance as specified in Section 87355(c)... This requirement is not met as evidence by: Based on interview and review of Guardian Background System Check facility Staff S1 and S2 are not criminal background clearanced and association to this facility. No documentation has been submitted to Community Care Licensing. This poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2023

Plan of correction: Administrator has agreed to email the completed criminal background clearance and associate Staff S1 and S2 to facility by POC due date.