Heavenly Castle Care

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA)'s Shawna Doucette and Daiquiri Boyd arrived at the facility unannounced to conduct an annual inspection. LPA was granted entry by Staff Siranoush Musayelya. LPA explained the purpose of the visit and staff contacted Administrator Hasmik Nshanyan who responded to the facility to assist with the visit. A tour of the facility was conducted with the Administrator. The residence was set at 72 F temperature and free of passageway obstructions inside and outside. Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked cabinet in the kitchen. Cleaning supplies were locked in the laundry room. Smoke detectors and carbon monoxide detectors were checked and operating. Fire drill was last conducted 09/01/25. LPA checked water temperature which measured at 119 F. Resident rooms were observed to be clean. Bathrooms have grab bars and skid mats. There was outdoor seating for the residents. Resident, medication and staff records were reviewed. Current first aid and CPR were reviewed. Staff had current training. A copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Oct 8, 2025

Allegation investigated: Staff did not provide an appropriate sleeping arrangement for a resident Staff do not provide a comfortable temperature for the residents Staff do not meet a resident's hygiene needs while in care Staff does not communicate effectively with a resident Staff interferes with a resident's outside communication

Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to commence a complaint investigation. LPA was granted entry by Staff Siranoush "Susan" Musayelyan. LPA contacted Administrator via telephone who gave permission for staff to assist with the visit. Administrator Hasmik "Jasmine" Nshanyan arrived at the end of the visit and signed for this report. LPA reviewed resident records. LPA interviewed staff and residents. LPA toured the facility. Facility temperature was set at 72 F and was operating. LPA observed R1's room two have two separate beds pushed together. R1 shares a room with another resident R3. Based on interviews and observation, LPA observed R1 and R3's beds pushed together, however after conducting interviews R1 and R3 requested the beds to be pushed together. LPA took photo of beds. Unsubstantiated Based on interviews and observation, LPA observed facility temperature to be set at 72 F and operating. Based on interviews, residents are comfortable with the temperature of the facility. It is unknown if there was a time the temperature was not comfortable. Based on interviews, residents hygiene needs are being met. Residents are receiving showers a minimum of twice per week and more if needed. It is unknown if there was a time a residents hygiene needs were not met. Based on interviews and observation, staff are able to communicate with residents in care. LPA spoke to S1 during the visit and the Administrator and we were able to communicate effectively. LPA conducted interviews and residents it was found that communication can sometimes be challenging but the residents needs are able to be met. It is unknown if there was a time a resident could not communicate with staff. Based on interviews, residents are receiving their outside communication via mail. It is unknown if there was a time a resident did not receive their mail. The Department has investigated the above allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 10, 2025 · control 24-AS-20250207112540

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA)'s Shawna Doucette and Brianna Miranda arrived at the facility unannounced to conduct an annual inspection. LPA was granted entry by Staff Siranoush Musayelya. LPA explained the purpose of the visit and staff contacted Administrator Hasmik Nshanyan who responded to the facility to assist with the visit. A tour of the facility was conducted with the Administrator. The residence was set at 72 F temperature and free of passageway obstructions inside and outside. Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked cabinet in the kitchen. Cleaning supplies were locked in the laundry room. Smoke detectors and carbon monoxide detectors were checked and operating. Fire drill was last conducted 10/03/43. LPA checked water temperature which measured at 96.2 F. There was outdoor seating for the residents. Resident, medication and staff records were reviewed. LPA observed a medication error for R3 on two of R3's prescribed medications. Pill count was off by one on both of the prescribed medications. Current first aid and CPR were reviewed. R1, R2 and R3 did not have Hospice Care Plans. A copy of this report with plans of correction with appeal rights were provided to Administrator. Civil penalty was issued for repeat medication error.the state’s words, verbatim · CDSS document, Nov 19, 2024

The state marks this report as 11 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff is unable to communicate effectively with the residents Staff charged a resident for services not received

Licensing Program Analysts (LPA)'s Shawna Doucette and Brianna Miranda contacted the facility to commence a complaint investigation. LPA's identified themselves and explained the purpose of the visit to staff. LPA Doucette contacted Administrator Hasmik "Jasmine" Nshanyan via telephone who responded to assist with the visit. During the course of the visit LPA's asked for resident files. Staff were unable to provide the files due to a language barrier. LPA's were able to obtain the files once the Administrator arrived. Based on observation and interviews staff are unable to communicate with residents at the facility. Based on records review and interviews, facility had receipts for a U- Haul to move R1's belongings out of storage, which does not match the receipt provided to the resident. Based on record review and interviews, staff charged a resident for services. Facility does not have a signed agreement from R1 for the facility to provide the service. Substantiated The Department has investigated the above allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was provided. Based on interviews and records review the preponderance of evidence standard has been met; therefore, the above allegations are found to be Substantiated. Per California Code of Regulations, Title 22, deficiencies are being cited on the attached 9099-D. An exit interview was conducted and a copy of this report along with appeal rights and plans of correction were provided.the state’s words, verbatim · CDSS document, Mar 7, 2024 · control 24-AS-20231208154942

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(d)(3) · Plan of correction due date: Mar 29, 2024

Personnel Requirements - General 87411 (d) 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 was not met as evidenced by Licensee did not ensure staff is able to communicate with LPA or residents which poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Plan of Correction POC Licensee agrees to submit a plan on how caregivers will be able to communicate with residents by POC due date

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(3)(B)1. · Plan of correction due date: Mar 15, 2024

87507 Admission Agreements (g) Admission agreements shall specify the following: (3) Payment provisions, including the following: (B) Rate for additional items and services, including 1. A comprehensive description of and the corresponding fee schedule for all additional items and services not included in the fees for basic services shall be listed. This requirement was not met as evidenced by: Licensee provided a service without completed receipts or a signed agreement between Licensee and resident which poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Plan of Correction Licensee agrees to submit a written statement on how this regulation will be met in the future by POC due date 03/15/24.

Type of visit: Case Management - Other

On 3/7/2024 Licensing Program Analysts (LPAs) B. Miranda and S. Doucette arrived to the facility unannounced to conduct a case management visit. LPAs introduced themselves and explained the reason for the visit. LPAs were allowed entry into the facility and Administrator (AD) Hasmik Nshanyan was contacted via phone. AD stated they were on their way and would arrive in about 45 minutes. LPAs observed facility to be clean, clutter & odor free. LPAs requested resident files to review while waiting for AD to arrive. Staff told LPAs to wait for AD. Due to staff not complying with LPAs requests to review resident records deficiency was cited. LPAs observed R1 & R2 in room 1. R1 has full bed rails on bed. LPAs reviewed R1's chart which did not indicate resident was on hospice and did not have a doctor's order on file for full bed rails. Due to facility not having proper documentation for full bed rails deficiency was cited. Resident records were reviewed. During the review R3's centrally stored log was not current and up to date. After reviewing R3's Oxycodone medication and AD conducting a medication count the start date did not match the medication count deficiencies were cited All deficiencies were cited under California Code of Regulations, Title 22, Division 6, Chapter 8, are being cited on the attached LIC 809D. Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights were provided to Hasmik Nshanyan.the state’s words, verbatim · CDSS document, Mar 7, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Mar 8, 2024

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Based on observation, interviews, and records reviewed the licensee failed to obtain proper documentation for R1 to have full bed rails on the bed. This poses an immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: AD removed the full bed rails from R1's bed. POC completed while LPA was in the facility.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(a)(6) · Plan of correction due date: Mar 8, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Based on observation, interviews, and records reviewed the licensee failed to properly log R3's narcotic medication Oxycodone. This poses an immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Administrator will complete log for Oxycodne. Statement will be provided to LPA by due date. POC completed while LPA was in the facility.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Mar 14, 2024

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Based on observation, interviews, and records reviewed the licensee failed to provide resident records when LPA’s requested. Staff was asked for resident files to review and told LPAs to wait for the administrator. This poses a potential health, safety, or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Administrator will conduct training with staff to provide requested documents/records to LPAs when requested.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Mar 8, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self administered medications as needed. This requirement is not met as evidenced by: Based on observation, interviews, and records reviewed the licensee failed to log centrally stored medication indicated medication started on Monday 4/4/24 and after the count indicated the start date was 3/6/24. There was no verifiable date the medication started and the count of R3's Oxycodone was incorrect.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Administrator will have Centrally stored log completed timely. Verification will be provided to LPA. POC completed while LPA was in the facility.

Type of visit: Required - 1 Year

LPA Shawna Doucette arrived at the facility unannounced to conduct an annual inspection. LPA was granted entry by Staff Vachagan Margaryan and Staff Arusyak Ayvazyan. LPA explained the purpose of the visit and staff contacted Administrator Hasmik Nshanyan who responded to the facility to assist with the visit. A tour of the facility was conducted with the Administrator. The residence was set at 68 F temperature and free of passageway obstructions inside and outside. Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked cabinet in the kitchen. Cleaning supplies were locked in the laundry room. Smoke detectors and carbon monoxide detectors were checked and operating. Fire drill was last conducted 10/18/23. LPA checked water temperature which measured at 111.2 F. There was outdoor seating for the residents. Resident, medication and staff records were reviewed. LPA observed a medication error for R1. R1 ran out of all medications however the start date was 10/16/23 for 30 pills which indicates R1 should have 7 pills remaining. R1 was out of PRN medications and facility did not have a log for the PRN medication. Current first aid and CPR were reviewed. R2 and R3 did not have Hospice Care Plans. Staff records indicate Staff Arusyak Ayvazyan was not cleared to be working in the facility. Refer to 809d for deficiencies. Civil Penalty was issued. A copy of this report with plan of correction and appeal rights were provided to the Administrator.the state’s words, verbatim · CDSS document, Nov 7, 2023

The state marks this report as 8 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.