Hollywood Healthy Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with Gayane Agazaryan for a Required One (1) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 01:00p.m. and the following was noted: The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The facility is fire cleared for six (6) non-ambulatory, of which one (1) may be bedridden in Room #2, and a hospice waiver for five (5). The facility is currently occupying four (4) residents. The living room and dining room are neat and clean. The facility has a total of four (4) bedrooms and two (2) bathrooms for residents. The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. (continued on LIC 809-C) Knives and sharps are observed to be locked and inaccessible to residents. Laundry detergents, cleaning agents and other toxins are locked away. The facility maintains a comfortable temperature at 76°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen and observed to be fully charged and last inspected April 10, 2026. The hot water temperature was measured at 107.3°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication to be locked and inaccessible to residents. Facility maintains a complete first aid kit. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, May 29, 2026

Type of visit: Required - 1 Year

On 4/28/2025 @ 10:30am, Licensing Program Analyst (LPA) Leizl de la Cerra conducted the required 1 year annual inspection with staff/caregiver, Siranush Mkhitaryan. Administrator, Gayane Agazaryan was contacted but was unavailable. LPA was informed by the administrator that Siranush Mkhitaryan was given consent to sign the report. This is a single story residence consists of four (4) bedrooms and two (2) bathrooms. Fire Clearance was approved on 01/17/2019 for five (5) non-ambulatory residents and one (1) bedridden in bedroom #2. All four (4) bedrooms are designated for resident use A tour of the physical plant was initiated at approximately 11:55pm and the following was observed: The smoke alarms and carbon monoxide detector are hard wired and inter-connected. Staff tested the dual smoke/carbon monoxide detector @12:30pm and was observed to be operational. The facility has two fully charged fire extinguishers inspected on 4/18/2025. One fire extinguisher is located in common room area, and the other in the kitchen. KITCHEN: The facility has a kitchen area that is equipped with a refrigerator, microwave oven and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives are kept in a locked box. There is a staff workstation located at the corner of the kitchen. BEDROOMS: There are four (4) bedrooms designated for resident use. Bedroom #1 and #2 are private rooms, with bedroom #2 having a bedridden fire clearance (per STD 850). Bedrooms #3 and #4 are shared rooms. The resident's bedrooms are furnished with beds, night stand, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space. BATHROOMS: The facility has two (2) bathrooms for the resident's use. Both bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water temperature measured between 106°- 110°F. COMMON AREAS: These included the living room and dining room. The living room was equipped with furniture, a television, tables and sofas. There is a fireplace with a screen. No fireplace tools or fixtures present. The dining area has a large dining room table to accommodate six (6). There were no visible immediate hazards. GARAGE/LAUNDRY ROOM: The washer and dryer is located in the garage, which is kept locked. The garage is also used as extra storage for non-perishable and emergency food supplies and water. MEDICATIONS: The medications are kept locked in a kitchen cabinet. Resident Files: LPA conducted reviews of all six (6) resident's files from 10:45am to 11:45am to insure compliance of licensing forms. Resident files are kept locked in cabinet, located the kitchen. Staff Files: LPA conducted reviews of three (3) staff member's files from 12:45pm to 1:30pm. Staff files are also kept in a locked cabinet located in the kitchen. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a patio and backyard furniture with umbrella to accommodate the six (6) residents. The facility backyard has sufficient yard space. LPA did not observe any body of water at this facility. During the visit today, LPA observed no deficiencies. Technical advisories provided. An exit interview was held. A copy of this report, technical advisory note was providedthe state’s words, verbatim · CDSS document, Apr 28, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced continuation of the annual visit from July 11, 2024. At 11:00AM Jassman Geragossian, caregiver greeted LPA at the entrance and LPA explained the reason for the visit. Jassman contacted the administrator, Gayane Agazaryan by phone. After Jassman spoke with administrator, Jassman informed LPA that administrator will not be available, because the administrator is at the hospital due to a knee problem. The administrator was not available either on the previous visit for annual inspection on July 11, 2024.At 11:15AM, required records were requested. Resident and Staff Records reviews: At approximately 11:45AM to 1:45PM, three (3) out three (3) resident records and four (4) staff records were reviewed to ensure compliance. Fire Clearance was approved on 01/17/2019 for five (5) non-ambulatory residents and one (1) bedridden in bedroom #2. All four (4) bedrooms are designated for resident use. Facility approved for five (5) hospice waivers. During staff records review LPA observed staff (S1) who was present at the facility giving care to residents, did not have a staff file. S1 did not have a fingerprint clearance and is not associated with the facility. At 2:00PM LPA with the assistance of the caregiver, took a tour of the facility. Common Area: LPA observed the living room and furniture to be clean and in good repair. The fireplace located in the living room is adequately closed and inaccessible to residents. The facility maintains a comfortable temperature at 76 degrees Fahrenheit. The air conditioner is operational. The facility smoke alarm system is hard wired and interconnected. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. At 2:15PM they were tested and deemed operational. Facility maintains a telephone land line and it was observed to be operational. Required postings were observed in the hallway. Each exit features a functioning auditory alarm. There were two (2) fire extinguishers, one in the kitchen area and one in the common area, both inspected on 4/02/2024. The facility is fire cleared for six (06) non-ambulatory residents; one (1) maybe bedridden in bedroom #2 approve for four (4) hospice waiver. Continued to LIC 809-C Kitchen: The kitchen appliances were functional. The kitchen has a working stove, faucet, refrigerator, and microwave. LPA observed enough food for at least three (3) days perishable and seven (7) days of non-perishable food at the facility which were all properly stored. Knives were stored in a locked drawer in the kitchen. Food preparation areas are clean. Garbage can has a tight fitting cover. Residents' dining table fits enough for six (6) people. Bedrooms: There are four (4) bedrooms that were properly furnished with appropriate dresser, night stand, lamp, chair, beddings, and linens. Extra linens, towels and beddings are stored in the hallway closets. Bedroom #1 and bedroom #3 is currently vacant. Bathrooms: There are two (2) bathrooms designated for residents use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 111.8 degrees and 109.6 degrees Fahrenheit. Surrounding Grounds: There is a patio furniture with a cover, appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have any bodies of water. Garage: The garage is attached and is accessible through the kitchen. LPA requested to observed the garage, the caregiver unlocked the door to the garage. Facility has a washer and dryer located inside the garage. The garage is also used for storing extra food supplies, toiletries, PPE supplies, and incontinence supplies. Laundry chemicals are also stored in the garage. The garage will remain locked and inaccessible to residents in care. LPA observed a 4 drawer locked cabinet in the kitchen area that contains all the residents' records, the staff records and the residents' medications. LPA observed each of the drawers to have separate locks, which is inaccessible to residents in care. First aid kit was missing a current or updated manual. Pursuant to Title 22 regulations, citations were issued and recorded on LIC809D. Exit Interview was conducted. Appeal rights was provided. A copy of the report provided.the state’s words, verbatim · CDSS document, Jul 23, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jul 24, 2024

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review... shall prior to working, in a licensed facility(1)Obtain a California clearance criminal record exemption as requiredt.This requirement is not met as evidenced by: Based on file review, the licensee did not comply with the section cited above for staff 1 (S1) who is a personal assistant for the resident (R1) at the facility.This poses an immediate health & safety risk to the residents in care.the state’s words, verbatim · CDSS document, Jul 23, 2024

Plan of correction: Administrator will submit for a criminal background clearance for S1 to the Department. A copy of the request will be emailed to LPA by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(a) · Plan of correction due date: Jul 30, 2024

87412(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information This requirement is not met as evidenced by: Based on observations and interviews, the facility did not ensure that a staff file was maintained at the facility for S1 who is there daily at least 6 hrs per day which poses a potential health and personal right risk to residents in care.the state’s words, verbatim · CDSS document, Jul 23, 2024

Plan of correction: Administrator will provide a copy of a complete staff file for S1 by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80075(g)(1)(A) · Plan of correction due date: Jul 30, 2024

80075 Health Related Services (g) first aid supplies shall be available in facility.(1)The supplies shall include:(A)Current 1st aid manual approved by American Red Cross, American Medical Assoc or state/federal agency. This requirement is not met as evidenced by: Based on observation, facility first aid supply kit did not have a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency.the state’s words, verbatim · CDSS document, Jul 23, 2024

Plan of correction: Administrator will provide by email a reciept of the purchaed First Aid Manual to LPA by POC date,

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced annual visit of the facility. At 2:45PM Jasmin Geragossian, who stated that she was a caregiver at the facility, greeted LPA at the entrance and LPA explained the reason for the visit. Jasmin contacted the administrator, Gayane Agazaryan, who was not present at the facility. LPA was informed that administrator will not be available. LPA De La Cera spoke with administrator over the phone and requested for the staff files and the residents' files. LPA was informed by the administrator that staff files are not in the facility. Staff files were removed out of the facility by the administrator in order for administrator to arrange and update the files. Due to unavailability of the staff files, LPA will continue the annual visit at a later time. Facility was issued a citation. Refer to LIC809-D. Exit interview conducted and a copy of the report was signed by caregiver. Copy of report was issued..the state’s words, verbatim · CDSS document, Jul 11, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(g) · Plan of correction due date: Jul 12, 2024

87412 Personnel Records (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement was not met as evidenced by: The Licensee removed personnel records/files of each staff out of the facility and licensing agency was unable to review personnel records/files. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 11, 2024

Plan of correction: Administrator to submit to the Department a complete personnel file of every staff member employed at the facility by 7/12/24. Administrator to submit a signed certification to the Department by 7/12/24 that completed personnel files shall be accessible and remain in the facility at all times.

Type of visit: Required - 1 Year

On 12/14/2023 at 09:00 AM, Licensing Program Analyst (LPA) Christopher Alemoh conducted an unannounced Required – Annual Continuation Inspection and met with Gayane Agazayan Administrator. Five (5) residents and two (2) staff were present during this inspection. Facility is licensed to serve six (6) non-ambulatory residents, five (5) may be bedridden in any room. The facility also has an approved hospice waiver for six (5) residents. The facility currently has 2 non-ambulatory residents. Residents are receiving Hospice services. The Annual Licensing Fees are current. The home consists of 1 floor level with: 1 staff room, 4 resident rooms, 2 restrooms, kitchen, dining room, and laundry room. The administrator accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. At 09:12 Staff began physical plant tour. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured between 106.2-107F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxics were locked and secured. First Aid kit was available stored in the garage. One fire extinguisher, last serviced July 23, 2024 was observed in the kitchen area. Second extinguisher located in the hallway charge date July 23, 2024. LPA tested all carbon monoxide detectors and smoke detector located in the kitchen area. Both devices were functional. LPA observed that all bedrooms and hallways are equipped with a carbon monoxide and smoke detector. At 10:45 AM LPA conducted a file review. 4 staff records were reviewed, 4 out of 4 staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions. 4 resident records were reviewed and, 4 out of 4 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. An exit interview was conducted, Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with Administrator Gayane Agazayan.the state’s words, verbatim · CDSS document, Dec 14, 2023