Jasmine

Type of visit: Required - 1 Year

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool. LPA Yee was let into the home by Gayane Yeghiazaryan, Staff. Jasmine Sargsyan, Licensee was contacted by staff and she arrived at 11:17am to conduct the visit. The reason for today's visit was provided. Arman Sargsyan, Administrator did not participate in today's visit.. The facility is a single storey family home consisting of a living room, dining room, kitchen, 3 bedrooms, 3 full bathrooms and a attached garage that was converted into a office/living quarters. The facility is fire cleared for 6 non-ambulatory residents only. On today's visit, all 12 domains of the CARE Inspection Tool was reviewed, 4 resident and 6 staff files were reviewed. The following were observed: the living room, dining room and kitchen were furnished and equipped with the appropriate furniture and equipment for its designated use and for the licensed capacity. The fire place located in the front room was observed with a fire screen. Bedroom #1 is currently rented as a private room and is furnished with 1 hospital bed, equipped with half bed rails, a night stand, a lamp, a chair, a dresser and a built in closet. Per Licensee, the second set of required furniture is in storage and will be provided if the room reverts back to a shared room. Bedroom #2 and Bedroom #3 are furnished with 2 each of the following: 2 hospital beds, 2 chairs, 2 night stands, 2 lamps, 2 dressers and a shared built in closet. The bed located to the right in bedroom #2 and the 2 hospital beds in bedroom #3 are equipped with a half bed rail. There are no written continued on LIC809-C Page 2. physicians order on file to indicate the need for any of the bed rails observed. A written physicians order was obtained for Resident #1 and Resident #3 and the 1/2 bed rails were removed from the two beds located in bedroom #3 during the visit. Window dressings were observed on all the windows for privacy. Linens were observed on the residents' beds as per personal preference and extra linens, blanket and towels were observed in the hallway linen closet. Also located in the hallway is a closet used to store hygiene products and detergent and cleaning solutions. All 3 common bathrooms are equipped with a walk in shower, a toilet and a single sink vanity. The common bathroom(#1) located between bedroom #2 and bedroom #3 and the one located closest to the living room(#2) were observed with grab bars, a shower chair, toilet risers and a slip resistant mats. The common bathroom by the front door(#3) is designated for staff use and does not have grab bars or slip resistant mat. Water temperature read 112.0 degrees in bathroom #1, 108.7 in bathroom #2 and 113.8 degrees in bathroom #3. Per review of the food supply, stored in the kitchen cabinets, there is sufficient perishable foods for a minimum of 2 days and sufficient non-perishable foods for a minimum of 7 days observed maintained on the premises. Current general liability insurance was reviewed and met Title 22 requirements Medications are centrally stored in a locked metal cabinet located in the dining room. The auditory devices on the four outside exiting doors - 2 in living room, front door and bedroom #3 were all tested and were operational. The only fire extinguisher located in the laundry room was last serviced on 6/23/26. The washer and dryer was observed being used during the visit. Paper goods, such as toilet paper, paper towels were also stored in the second closet. The hardwired smoke detectors and the only combination smoke/carbon monoxide detector located in the resident hallway were tested and were operational. Clarification will be obtained regarding the use of door stoppers on the fire rated bedroom doors. continued on LIC809-C Page 3. LPA Yee verified with the Licensee that the facility telephone number on the facility profile has not changed. The first aid kit was reviewed and met Title 22 requirements. First aid manual was observed. All staff have current first aid training. The attached garage, located in the front is still used as an office The backyard has a gazebo furnished with chairs and a coffee table for resident activities. Also located in the backyard are 3 storage sheds used to store supplies. Trash cans stored in the front yard were observed to be tightly sealed. Overall, the inside and outside of the facility was observed to be clean and well maintained. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview was conducted, Appeals Rights discussed and a copy was provided.the state’s words, verbatim · CDSS document, Aug 11, 2026

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool. LPA Yee met with Jasmine Sargsyan, Licensee and the reason for today's visit was provided. Arman Sargsyan, Administrator was out of town and did not participate in todays visit.. The facility is a single storey home consisting of a living room, dining room, kitchen, 3 bedrooms, 3 full bathrooms and a attached garage that was converted into a office/living quarters. The facility is fire cleared for 6 non-ambulatory residents only. All 12 domains of the CARE Inspection Tool was reviewed on today's visit. Also reviewed on today's visit were all 5 resident files and 6 staff files. The following was observed on today's visit: the living room, dining room and kitchen were furnished and equipped with the appropriate furniture and equipment for its designated use and for the licensed capacity. The fire place in the front room was observed with a fire screen. The only fire extinguisher is located in the laundry room, located next to the kitchen, was last serviced on 7/29/25. Sufficient perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed. Sharp knives are stored in a locked kitchen drawer continued on LIC809 Soap, cleaning solutions, hygiene products are stored in a locked cabinet in the laundry room. Additional hygiene products are also stored in the common bathroom located by bedroom #3 All three bedrooms were furnished with 2 each of the following: 2 hospital beds, 2 chairs, 2 night stands, 2 lamps, 2 dressers and a shared built in closet.. The common bathroom by the front room has a toilet, a single sink vanity and a tub with a shower. Grab bars, a shower chair and a slip resident mat was observed. Water temperature was tested and read 115.7 degrees Fahrenheit. The common bathroom located by bedroom #3 has a walk in shower with grab bars, shower chair, slip resident mat, a toilet with a riser, and a single sink vanity. Water temperature was tested and read 112.3 degrees Fahrenheit. The third full bathroom located by the front door is designated for staff use. The first aid kit was reviewed and contained gauze, bandages, band aid, a tweezer and a pair of scissors. An external thermometer was also observed. Medications are stored in a locked cabinet in the living room. Oxygen is in use in the home and signs were posted. However, it was suggested that larger signs be posted so it is more visible. Per Licensee, a written notice was sent to the local fire department. The required posters were observed. The garage was also toured and is still being used as an office and for staff use. the hardwired smoke detectors and combination smoke/carbon monoxide detectors located inside the resident rooms, resident hallway and in the dining room were tested and were operational. the auditory devices on the outside exiting doors located in bedroom #3, front door and the 2 sliding glass doors in the living room were tested and were operational. The window screens in bedroom #2 and common bathroom are warped and missing a screen, bedroom #3 is missing a screen and the sliding screen door is warped. Per Licensee, new screens were ordered and the vendor was supposed to replace the screens on 8/19/25 and did not show up as scheduled. Copy of the emailed appointment confirmation was obtained. The Licensee was given 2 weeks(9/3/25) to resolve installation with the vendor and provide evidence of completion. Located in the backyard is a detached covered patio furnished with wicker chairs and a coffee table. The backyard was observed to be clean The front yard was also toured and it was observed to be clean. Trash cans were observed on the curb for pickup for the following day. Exit interview was conducted.the state’s words, verbatim · CDSS document, Aug 20, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool. LPA Yee was let into the facility by Gayane Yeghiazaryan, Staff. Arman Sargsyan, Administrator was contacted by telephone and he arrived at 11:51 am to conduct the visit. Jasmine Sargsyan, Licensee arrived 11:56 am to also participate in the visit. The facility is a single storey home consisting of a living room, dining room, kitchen, 3 bedrooms, 3 full bathrooms and a attached garage that was converted into a office/living quarters. The facility is fire cleared for 6 non-ambulatory residents. All 12 domains of the CARE Inspection Tool was reviewed on today's visit. Also reviewed on today's visit were all 6 resident files and all 7 staff files. The following were observed on today's visit: the living room, dining room and kitchen were furnished and equipped with the appropriate furniture and equipment for its designated use and for the licensed capacity. The fire place in the front room was observed with a fire screen. All the bedrooms were equipped with 2 each of the following: 2 hospital beds, 2 chairs, 2 night stands, 2 lamps, 2 dressers in bedroom #1, 1 shared dresser in bedroom # 2 and bedroom #3 and a shared closet in all the bedrooms. The common bathroom by the front room has a toilet, sink and a tub with a shower. Grab bars, a shower chair and a non-skid mat was observed. Water temperature was tested and read 113.6 degrees Fahrenheit. The common bathroom located between bedroom #2 and #3 has a walk in shower, a toilet, and a sink Grab bars, a non-skid mat and a shower chair was observed. Water temperature was tested and it read 113.7 degrees Fahrenheit. the linen closet located in the bedroom hall was observed with extra linens, towels and blankets. medications are stored in a locked cabinet in the living room The laundry room located by the kitchen was observed with a washer and dryer. Cleaning solutions and disinfectants are locked in a cabinet in the laundry room the only fire extinguisher purchased on 7/10/24 is located on the wall between the kitchen and laundry room. Sufficient perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed. The auditory devices on the front door, the sliding glass door in the living room and bedroom #3 were all operational. Hygiene products were observed stored in locked cabinets the laundry room and in the common bathroom. The facility has current liability insurance with limits meeting Title 22 requirements until September 2024. First aid kit with a pair of scissors, tweezer, thermometer and a first aid manual was observed. The interconnected smoke detectors and a smoke/carbon monoxide detector located in the bedroom hallway were tested and they were operational. Required posters were observed. Per tour of the backyard, a gazebo with tables and chairs were observed. 3 storage sheds were also observed. the trash cans stored in the front yard was observed to be in good condition and tightly sealed. The front and backyard were observed to be clean. Deficiencies were cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Civil penalties were assessed. Exit interview was conducted, Appeals Rights were discussed and a copy was given.the state’s words, verbatim · CDSS document, Aug 16, 2024