Hampton Villa

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 - Michael Petrosian and explained the reason for the visit. The facility is licensed to serve Elderly residents ages 60 and above with developmental disabilities. Facility is approved to serve (6) Non-Ambulatory residents with hospice waiver for three (3). Current census is six (6) and all residents are receiving services through Frank D. Lanterman Regional Center. The facility is a single-story structure located in a residential neighborhood. It consists of the following: Three (3) resident's rooms, two (2) common bathrooms, living room, dining room, kitchen, laundry room, a covered patio and a detached garage used for storage. At 11:25am, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed by the entry door. The smoke and carbon monoxide detectors are hardwired and interconnected. At 10:48am smoke/carbon monoxide detectors were tested and observed to function properly. The fire extinguisher is located in the laundry room, purchased on 01/28/2025. Facility conducts emergency drills quarterly, the last Fire Drill was conducted on 09/03/2025 and the last earthquake drill was conducted on 08/04/2025. Kitchen: The kitchen appliances and work surfaces are clean and sanitary. Appliances consisted of refrigerator, stove/oven, microwave and counter-top oven and all appliances were observed to be functional. Facility has 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 chemicals were observed to be stored in locked cabinet underneath the sink. The laundry area is located off the kitchen and during the visit, LPA observed the machines to be in working condition. There is an exit door in the kitchen, leading to the backyard. Continue on 809-C Bedrooms: There are three (3) shared bedrooms designated for residents' use. All of the bedrooms, in use by residents were were properly furnished with appropriate beds, chairs, dresser drawers, beddings and linens. Bedrooms 1 and 3 had ceiling fans and all the bedrooms had television sets. All bedrooms were observed to be extremely clean and organized. Bathrooms: There are two (2) bathrooms designated for residents' use, one is a half bathroom and the other is full bathroom. Both bathrooms had required functional fixtures, grab bars and the full bathroom had non-skid tiles in the shower. Hot water temperature was measured between 108.5 and 109.7 degrees Fahrenheit. Common Areas: These included a living room and dining room. There is a non-functional covered fireplace in the living room. In the living room there is a television, internet and wi-fi access for clients' use. The common areas were properly furnished with sofas, tables with ample seating for all residents and staff. Surrounding Grounds: There are no bodies of water present. There are two exit doors, one in the kitchen and one in the living room, used as emergency exits. All walkways and exit passages were free of obstruction. There is a covered patio with two sets of furniture. There is a detached garage, currently used to store emergency water, food and additional supplies. LPA observed two refrigerators, stocked with clearly marked perishable food supplies in the garage. Medication/Resident Files: Medication, first aid kit/manual are kept locked in a hallway closet. Medications for 3 out of 6 residents were counted and records were reviewed for accuracy of administration. LPA conducted a file review of 3 out of 6 resident records to ensure compliance of licensing forms and current physician records. P&I for 3 out of 6 residents were counted and compared to receipts. Staff Files: LPA conducted a file review of 5 staff records to ensure forms and training are up to date and compliant with licensing forms. Operational Requirement: Liability Insurance was reviewed with expiration date of 04/01/2026, in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. Surety Bond was reviewed with expiration date of 11/12/2026, approved in the amount of $10,000.00. Administrator Certificate expiration date is 08/10/2027. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit Interview Conducted / A Copy of the Report Issued.the state’s words, verbatim · CDSS document, Oct 30, 2025

Type of visit: Required - 1 Year

On 10/12/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with administrator Michael Petrosian and explained the purpose of today’s visit. The facility is licensed to operate for six (6) non-ambulatory. The facility is approved for (3) hospice residents. Currently, the facility has (0) residents in hospice care. The residents are Lanterman Regional Center consumers. The facility is a single-story structure located in a residential neighborhood. It consists of the following: three (3) resident's rooms, two (2) common bathrooms, a living area, a dining area, a kitchen, an outside covered patio area, and garage used for storage. LPA and administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 107.0-degree F. A comfortable temperature of 72 degree was maintained in the facility. LPA observed the facility to be clean, sanitary, and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Fire extinguishers were charged, smoke detectors and carbon monoxide were operable. A review of the Medication Administration Record (MAR) was complete and accurate. The facility has conducted a disaster drill on 10/01/24. A landline telephone was in working condition. A review of staff CPR/First Aid training is current. Evaluation Report Continues LIC 809-C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. The facility has current liability insurance on file effective 04/01/24 – 04/01/25. The facility is current on Community Care Licensing annual dues. An audit of residents #1-#6 (R1-R6) service files and staff #1-#3 (S1-S3) personnel files revealed to be complete. The facility has the current administrator's certification on file for Michael Petrosian #7035389740 Exp. 08/10/25. No deficiencies during this inspection visit. An exit interview was conducted with Michael Petrosian, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 12, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Antonia Alvizar conducted an unannounced Annual Required visit to this facility. LPA met with Administrator, Michael Petrosian and explained the reason for the visit. At 11:00a.m. LPA and Administrator tour of the physical plant for compliance with safety, maintenance, and operational requirements. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Facility is a single-story house in a residential neighborhood and consisting of a common area, three (3) bedrooms, one (1) full bathroom and a half (1/2) restroom currently occupying six (6) residents. There is one entrance being utilized at the facility, there are required posters at the main door. Smoke detectors are hard wired and are interconnected. Smoke detectors and Carbon Monoxide detectors were tested and function properly. Facility disaster drills was conducted on 11/01/2023. The facility maintains a comfortable temperature at 74°F. There is a charged fire extinguisher in the facility. Fire extinguisher is located in the laundry room. Fire extinguisher is fully charged and receipt of purchased was 01/09/2023. Cleaning supplies and toxic substances are inaccessible to residents. Hot water temperature was tested in common bathroom and in the kitchen. The hot water temperatures measured between 107.2 - 110.1 degrees Fahrenheit (F) which are within the required range for residents comfort and safety. Kitchen: The kitchen appeared clean and fixtures functional. Kitchen knives and other sharp items are stored in a lock drawer in the kitchen. The supply of dishes and eating utensils was more than adequate. Household cleaning and supplies are kept locked in a cabinet under the sink. On the premises that is in the kitchen there was a functional telephone. Laundry Room: Equipped with washer and dryer. Laundry supplies are kept locked in a cabinet. Located next to the kitchen. Continued from 809) Bedrooms: The residents’ bedrooms were properly furnished and had adequate lighting and closet space. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: LPA observed all bathrooms to be clean, properly supplied and had functional fixtures. LPA observed grab bars in both bathrooms. The full bathroom had non-skid mat in shower. Residents have enough personal hygiene supplies. Common Areas: The living room has a television, a couch and two (2) recliner chairs. The common areas were checked for cleanliness and furniture was checked for functionality. All areas were clean, sanitary and in good repair. At 2:46p.m. LPA observed residents having snack. At 3:15pm LPA observed residents having coloring in the dining table. Surrounding Grounds (Outdoors): There was a shaded area with proper furniture for outdoor use in the back of the facility. There are no bodies of water and firearms on the premises. Garage: Detached located in the rear of the facility, which stores personal protected equipment (PPE), emergency food, maintenance supplies, two (2) operation refrigerators with extra Non-perishable and perishable food. In addition to the physical plant LPA conducted a file review for all residents and staff regularly scheduled. Staff have current first aid and training documentation showing required training completed. Resident records observed to be complete at this time. Per California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, deficiencies were not observed/cited. Exit interview conducted and copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Nov 27, 2023