Greenbush Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility to conduct an unannounced required annual visit at 1:42PM. The LPA met with Licensee Kajo Movsesian. Entrance interview conducted. Beginning at 1:56PM, the LPA and the Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: At the time of the visit, the living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature throughout the visit. LPA Huynh noted required signage and postings in the facility’s entryway. The LPA observed nightlights throughout the facility’s hallways. Additionally, a laundry closet is in the hallway and was observed to be operable and in good condition. Additional closet storage was in the dining room that contained extra linens and clothes. Report Continued on LIC 809-C BEDROOMS/RESTROOMS: There were four (4) total bedrooms: three (3) private and one (1) shared. Bedrooms #1, #3, and #4 had direct exits to the outside and were approved for two (2) total bedridden residents. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There were two (2) total restrooms in the facility, both shared. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap and paper products. Hot water was tested and measured between 111.6 degrees F and 113 degrees F. KITCHEN: Knives were stored inaccessible in a locked drawer. Cleaning supplies were inaccessible under the sink. Kitchen appliances were clean and in operable condition. The facility had a sufficient supply of perishable and non-perishable food, as well as emergency food and water. Food in the refrigerator was observed to be of good quality. Files, medications, and the first aid kit were stored in a locked cabinet. OUTDOOR AREA: The backyard had an area equipped with furniture for resident and visitor use. There is one (1) self-latching side gate for emergency use. No bodies of water noted, and exits were free of obstructions. The facility had two (2) outdoor sheds that contained cleaning equipment and facility supplies. In the rear, there was an Additional Dwelling Unit (ADU) that was inaccessible to residents and occupied by unrelated individuals. RECORDS: Record review began at 2:10PM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Report Continued on LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 04/30/2026. Combination smoke and carbon monoxide alarms were tested at 2:50PM and were operational. Two (2) fire extinguishers were observed throughout the facility and were serviced 04/08/2026. MEDICATIONS: Medication review began at 2:53PM. Medications were centrally stored and kept inaccessible in the kitchen. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates. Medications were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. No deficiency cited. Exit interview conducted. A copy of today's report was reviewed and provided.the state’s words, verbatim · CDSS document, Jun 16, 2026

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility to conduct an unannounced Post-Licensing visit at 12:15PM. The LPA was greeted by staff, informed them of the reason for the visit, and staff notified the Licensee. The Licensee Kajo Movsesian arrived shortly thereafter. Entrance interview conducted. Beginning at 12:34PM, the LPA and the Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: At the time of the visit, the living room and dining room furniture was observed to be in good condition. The living room had a screened and inoperable fireplace. The facility maintained a comfortable temperature throughout the visit. LPA Huynh noted required postings in the facility’s entryway. Two (2) fire extinguishers were observed throughout the facility and were purchased within the last year. LPA observed nightlights throughout the facility’s hallways. Additionally, a laundry closet was in the hallway and was observed to be operable and in good condition. An additional closet was was the dining room that contained linens and clothes. Report Continued on LIC 809-C KITCHEN: Knives were stored inaccessible in a locked drawer. Cleaning supplies were inaccessible under the sink. Kitchen appliances were clean and in operable condition. The facility had a sufficient supply of perishable and non-perishable food, as well as emergency food and water. Food in the refrigerator was observed to be of good quality. Files, medications, and the first aid kit were stored in a locked cabinet. BEDROOMS/RESTROOMS: There were four (4) total bedrooms: two (2) private and two (2) shared. Bedrooms #1, #3, and #4 had direct exits to the outside and were approved for bedridden residents. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There were two (2) total restrooms in the facility, both shared in the hallways. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap and paper products. Hot water was tested and measured between 118.2 degrees F and 118.9 degrees F. OUTDOOR AREA: The backyard had an area equipped with furniture for resident and visitor use. There was one (1) self-latching side gate for emergency use. No bodies of water noted, and exits were free of obstructions. The facility had two (2) outdoor sheds that contained cleaning equipment and facility supplies. In the rear, there was an Additional Dwelling Unit (ADU) that was inaccessible to residents and occupied by unrelated individuals. RECORDS: Record review began at 12:56PM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Report Continued on LIC 9099-C INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 07/15/2025. Combination smoke and carbon monoxide alarms were tested at 12:54PM and were operational. MEDICATIONS: Medication review began at 2:29PM. Medications were centrally stored and kept inaccessible in the kitchen. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates. Medications were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. No deficiency cited. Exit interview conducted. A copy of today's report was reviewed and provided.the state’s words, verbatim · CDSS document, Sep 2, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Quoc Huynh and Kelly Dulek conducted a pre-licensing visit to the above noted facility. At 11:00AM, the LPAs met with applicant, Kajo Movsesian. An application to operate a Residential Facility for the Elderly was submitted on 10/18/2024. A dementia program was included in the plan of operation. A Hospice Waiver for 6 (six) has been requested. The facility's fire clearance was approved on 01/22/2025 for two (2) bedridden and four (4) non-ambulatory, with a total capacity of six (6) residents. Component II orientation was completed on 05/01/2025. Component III was completed with the applicant during today's visit. The facility is a single-story home located in Van Nuys. Beginning at 11:05AM, a physical plant tour was conducted. The following was observed: BEDROOMS/BATHROOMS: The facility has four (4) bedrooms. Bedrooms #1, #3, and #4 have a direct access to the outside and is cleared for bedridden residents. Resident rooms are set up with beds, nightstands, lamps, chairs, sufficient clothing storage and closet space. The beds are furnished with box springs, comfortable mattress and clean linen, which includes, a mattress pad, top and bottom linens, pillowcases, and blanket (if needed). Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All rooms were free of odors. All window screens were clean and maintained in good repair. Report Continued on LIC 809-C There are two (2) bathrooms, both shared. The bathrooms have a shower with non-slip mats. The toilet and shower have grab bars. The hot water temperature was tested and measured within the required range of 105*F to 120*F. COMMON AREAS: Common areas were appropriately furnished, and the lighting was adequate. There is a television, reading materials, and/or activity supplies in the living room. There is a fireplace that was properly screened. There was sufficient space to accommodate both indoor and outdoor activities. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included but not limited to flashlights. Night-lights were observed throughout the common areas. The facility had emergency food and water available. The facility has central heating and air conditioning to maintain rooms to a comfortable temperature. At 12:33PM, the hardwired combination smoke and carbon monoxide detectors were tested and functioned properly. The fire extinguishers throughout the facility were fully charged and purchased on 05/24/2025. The supply of extra bed and bath linens as well as personal hygiene items were adequate. Extra incontinence supplies and other supplies are located outside in the locked storage shed. There is a washer and dryer closet located in the hallway and observed to be in good condition. There is a functioning telephone on the premises. All required postings are posted near the entrance of the facility. KITCHEN: Knives are stored in a locked kitchen drawer. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit and the refrigerator was maintained at 40*F. The supply of nonperishable foods and emergency food supply is adequate. Cleaning supplies are stored in a locked cabinet under the kitchen sink. There are no pesticides or toxins stored in any food storage area or preparation area. Appliances in the kitchen were clean and all appeared functional. Medication will be stored in a locked kitchen cabinet. Report Continued on LIC 809-C Files will be stored in a separate locked kitchen cabinet. First aid kit was observed to be complete, including a thermometer and a current version of a first aid manual. OUTDOOR AREA: The exterior passageways were clean and clear of any obstructions. There are two areas at the back of the house with tables and chairs where residents can sit. The outdoor space is property gated. There are two storage sheds in the back yard intended for extra supplies. There are no bodies of water on the premises at the present time. No corrections required. Exit interview conducted. A copy of the report was issued. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.the state’s words, verbatim · CDSS document, May 28, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): N/A COMP II Participants: Licensee/administrator Kajo Movsesian Interview Method: Telephone interview On 5/1/2025, 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 that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. 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. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, May 1, 2025