Hartland Care

Type of visit: Required - 1 Year

At 09:00 AM, Licensing Program Analyst (LPA) Huma Rahimi, conducted an unannounced annual visit. LPA met with staff, Hasmik Mandlyan,and the staff contacted the Administrator. LPA explained the reason for the visit. The Administrator arrived at 9:30 AM. The physical plant tour was conducted and LPA observed the following: The facility is a single story building with four (4) bedrooms, two (2) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (6) nonambulatiory residents, of which one (1) may be bedridden in Bedroom # one (1). The facility serves residents with dementia. Approved hospice waivers for six (6). The facility uses surveillance cameras on the interior and exterior. Kitchen: At approximately, 9:35 AM LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen cabinet. A fully charged fire extinguisher hung near the kitchen purchased on 03/01/2025. Laundry Room: At 9:40 AM, LPA observed that the cleaning solutions were locked in the laundry room, located next to the kitchen. A washer and dryer in good condition and LPA observed both were running washing and drying cloths. Medications: At approximately, 9:42 AM LPA observed medications are centrally stored and were locked near the dining room cabinet. Bedrooms: The facility has four (4) bedrooms. Two (2) are private and two (2) are shared. All bedrooms contained a nightstand, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Bedroom four (4) is vacant. Continue on LIC809-C Bathrooms: The facility has two (2) bathrooms. One of the bathrooms is designated for staff and the other for residents. The bathroom designated for residents contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight-fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At 9:40 AM, hot water temperature measured at 118.3°F. A closet in the hallway contained a sufficient supply of linens. Common Areas: The facility maintains a comfortable temperature at 78°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. Outside areas: At approximately, 9:50 AM, LPA toured the outside area of the facility. LPA observed a covered patio area outside with furniture in good repair. The emergency exit was unlocked with an inward facing latch. Emergency exit paths were free from debris. The garage is attached to the home without an excess from the home and is kept locked inaccessible to residents. Smoke detectors/carbon monoxide. At 9:55 AM, LPA tested the dual-function smoke and carbon monoxide detector to be operational. Two (2) out of two (2) detectors were functioned during the test, and an additional verbal alert sounded. Between 10:15 AM to 11:45 AM, LPA reviewed records of six (6) residents and two (2) staff. Residents and staff records were updated and completed. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. No deficiency issued. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Aug 4, 2025

Type of visit: Required - 1 Year

At 09:40 AM, Licensing Program Analyst (LPA) Huma Rahimi, conducted an unannounced annual visit. LPA met with staff, Hasmik Mandlyan,and the Administrator was contacted. LPA disclosed the reason for the visit and the Administrator, Dianna Makaryan and the Administrator arrived at 10:15 AM. LPA and Administrator toured the facility inside and out. The facility is a single story building with four (4) bedrooms, two (2) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (6) nonambulatiory residents, of which one (1) may be bedridden in Bedroom # one (1). The facility serves residents with dementia. Approved hospice waivers for six (6). The facility uses surveillance cameras on the interior and exterior. Kitchen: At approximately, 10:15 AM LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen cabinet. A fully charged fire extinguisher hung near the kitchen purchased on 02/14/2024. Laundry Room: At 10:17 AM, LPA observed that the cleaning solutions were locked in the laundry room, located next to the kitchen. A washer and dryer in good condition and LPA observed both were running washing and drying cloths. Medications: At approximately, 10:20 AM LPA observed medications are centrally stored and were locked near the dining room cabinet. In Room # three (3), LPA observed anti-itch ointment accessible to residents in care. Bedrooms: The facility has four (4) bedrooms. Two (2) are private and two (2) are shared. All bedrooms contained a nightstand, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Bedroom four (4) is vacant. Continue on LIC809-C Bathrooms: The facility has two (2) bathrooms. One of the bathrooms is designated for staff and the other for residents. The bathroom designated for residents contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight-fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At 10:26 AM, hot water temperature measured at 114.3°F. A closet in the hallway contained a sufficient supply of linens. Common Areas: The facility maintains a comfortable temperature at 78°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. Outside areas: At approximately, 10:30 AM, LPA toured the outside area of the facility. LPA observed a covered patio area outside with furniture in good repair. The emergency exit was unlocked with an inward facing latch. Emergency exit paths were free from debris. The garage is attached to the home without an excess from the home and is kept locked inaccessible to residents. Smoke detectors/carbon monoxide. At 11:20 AM, LPA tested the dual-function smoke and carbon monoxide detector to be operational. Two (2) out of two (2) detectors were functioned during the test, and an additional verbal alert sounded. Between 11:45 AM to 1:20 PM, LPA reviewed records of five (5) residents and two (2) staff. LPA observed that five (5) out of five (5) residents files were incomplete or not updated. Additionally, LPA observed that two (2) out of (2) staff required training were not updated or completed. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. Citations were issued. Appeal rights explained. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Aug 12, 2024

Type of visit: Required - 1 Year

At 11:45 AM, Licensing Program Analyst (LPA) Huma Rahimi, conducted an unannounced annual visit. LPA met with Administrator, Dianna Makaryan and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out. The facility is a single story building with four (4) bedrooms, two (2) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (6) nonambulatiory residents, of which one (1) may be bedridden in Bedroom # one (1). The facility serves residents with dementia. Approved hospice waivers for six (6). The facility uses surveillance cameras on the interior and exterior. Kitchen: At approximately, 11:55 AM LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen cabinet. A fully charged fire extinguisher hung near the kitchen serviced on Laundry Room: At 12:00 PM, LPA observed that the cleaning solutions were locked in the laundry room, located next to the kitchen. A washer and dryer in good condition and LPA observed both were running washing and drying cloths. Medications: At approximately, 12:05 PM LPA observed medications are centrally stored and were locked near the dining room cabinet. Bedrooms: The facility has four (4) bedrooms. Two (2) are private and two (2) are shared. All bedrooms contained a nightstand, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Bedroom # one (1) and bedroom # three (3) were vacant. Continue on LIC809-C Bathrooms: The facility has two (2) bathrooms. One of the bathrooms is designated for staff and the other for residents. The bathroom designated for residents contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight-fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At 12:12 PM, hot water temperature measured at 117.2°F. A closet in the hallway contained a sufficient supply of fresh linens. Common Areas: The facility maintains a comfortable temperature at 73°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. Smoke detectors/carbon monoxide. At 12:15 PM, LPA tested the dual-function smoke and carbon monoxide detector to be operational. Two (2) out of two (2) detectors were functioned during the test, and an additional verbal alert sounded. Outside areas: At approximately, 12:20 LPA toured the outside area of the facility. LPA observed a covered patio area outside with furniture in good repair. The emergency exit was unlocked with an inward facing latch. Emergency exit paths were free from debris. The garage is attached to the home without an excess from the home and is kept locked inaccessible to residents. Between 12:30 PM to 2:15 PM, LPA reviewed records of three (3) residents and three (3) staff. Residents and staff records appeared to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. Exit interview conducted and copy of this report signed and delivered. No citations issued.the state’s words, verbatim · CDSS document, Mar 14, 2024

Allegation investigated: Residents are not being showered Staff physically abuses the resident in care Facility financially abused resident in care.

At 10:00am, Licensing Program Analysts (LPAs) Angela Panushkina, Leslie Ngo-Castaneda and Huma Rahimi conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPAs met with Reuel Staff #1 (S1), who granted access to the facility. Administrator arrived shortly after and LPAs explained the reason for the visit. During course of the investigation, interviews and record review were made. At 10:10am, LPAs requested resident and staff roster. At 10:20am, LPAs requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, etc., relevant to the investigation. However, only facility Admission Agreement and former Admission Records from Santa Paula Hospital, for R1, were available. At approximately 10:30am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:40am – 12:10pm, LPA interviewed the Administrator, two (2) staff and four (4) residents and two Assisted Living Waver (ALW) Social Workers. Continue on LIC9099-C Unsubstantiated Allegation: Residents are not being showered It is alleged that staff do not provide showers to residents on a regular basis. To investigate this allegation, LPAs conducted an interview with two (2) out of four (4) residents, who was able to communicate, and were informed that the facility provides showers and they had no concerns regarding this allegation. In addition, LPAs observed all four (4) residents appeared to be clean, well groomed and well taken care of. Moreover, interviews with the Administrator and two (2) staff members revealed that the facility provides showers at least twice a week or as needed. In addition, review of records also revealed that three (3) out of four (4) residents receive hospice services and are scheduled to have two (2) showers weekly and one (1) resident is being provided two (2) showers weekly by the Home Health Agency aid. Allegation: Staff physically abuses the resident in care It is alleged that a facility caregiver abuses other residents by slapping them on their hands. LPAs conducted an interview with two (2) out of four (4) residents, who were able to communicate, and were informed that the facility staff are nice and take good care of them. Moreover, LPAs conducted an interview with the Administrator and two (2) staff members and all denied the allegation and reported no resident ever complained being physically abused. Lastly, LPA Panushkina interviewed two (2) Social Workers over the phone and both informed LPA that they've visited this facility numerous times and never witnessed any staff members physically abusing residents. Allegation: Facility financially abused resident in care It was alleged that facility financially abused resident (R1) in care. LPAs conducted an interview with two (2) out of four (4) residents, who were able to communicate and were informed that the facility has no access to their finances and their family take care of everything for them. In addition, LPAs conducted an interview with the Administrator and two (2) staff members and all denied ever having access to R1's or other residents' finances/bank accounts. LPAs were also informed by the Administrator that R1 purchased a lot of cannabis. Moreover, interview with two (2) social workers confirmed that due to R1's drug use in the past, R1 spend majority of his/her money to buy edibles/cannabis. Based on inspection, observation and interviews there is no sufficient evidence to support the allegation. Therefore, all allegations are Unsubstantiated at this time. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Oct 3, 2023 · control 31-AS-20230926084656

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Angela Panushkina, Huma Rahimi and Leslie Ngo-Castaneda conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20230926084656. LPA met with the Administrator and explained the reason for the visit. During the visit, LPAs observed four (4) incidents, involving R5, took place between 03/16/23 to 06/03/23 and were not submitted to the Community Care Licensing Department (CCLD) in a timely manner. Moreover, Administrator informed LPAs that R1 was hospitalized on 09/19/23. LPAs reviewed all incident reports on a system and did not observe an Incident Report regarding R1. In addition, the Administrator admitted that no incident was submitted to the Regional Office (RO). Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPAs informed the Administrator that all staff members are mandated reporters and they are all responsible for reporting. LPAs informed the Administrator to submit the following five (5) incidents that occurred on: 03/16/23 (one incident) 03/18/23 (one incident) 05/20/23 (one incident) 06/03/23 (one incidents) 09/19/23 (one incident) In addition, review of R1's record revealed that the facility file is incomplete/missing documents. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D. Exit interview conducted, appeal rights and copy of report signed and delivered.the state’s words, verbatim · CDSS document, Oct 3, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)A,B&D · Plan of correction due date: Oct 10, 2023

Requirements (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person... ... any of the events specified in (A), (B) & (D)... This requirement is not met as evidenced by: Based on interviews and record reviews, conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding the five (5) incidents that occured between 03/16/23 -09/19/23, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 3, 2023

Plan of correction: Licensee shall ensure a written report is submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of any of the events. Copies of all 5 incidents, shall be submitted to LPA by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(a) · Plan of correction due date: Oct 10, 2023

87506 Resident Records: (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. Resident records were incomplete and or missing documents, which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 3, 2023

Plan of correction: Licensee agreed to complete four (4) out of four (4) resident files.