La Senior Home

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Trevor Byrne conducted a Case Management – Other inspection at the facility today due to the closure of the licensed facility. LPA arrived at the facility at 09:30 AM and met with the facility Administrator Tigran Gevorgyan. Entrance interview was conducted and the reason for the visit was explained. On May 27, 2026, the Department was advised by the Administrator that they no longer had any residents in care and wished to close the facility. Today’s inspection was to ensure that there were no longer any elements of care or supervision being provided at this location and to officially close the facility. At 09:31 AM, LPA conducted a brief tour of the home. During the inspection, the LPA found no evidence to support that the home is being operated as a licensed facility. The Administrator was unable to surrender the license for this location as they stated the license had been discarded along with other items while they were cleaning the location out. LPA informed the Administrator that as of today’s date (05/28/2026) license #195850350 is officially closed and no future care and supervision may be provided under this license number. The Administrator understood that if they wish to operate a community care facility at this location again, they must apply for a new license and cannot start operation until a new license is issued. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, May 28, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 09:45 AM. LPA met with facility staff and contacted the facility Administrator Tigran Gevorgyan. The Administrator arrived to the facility at approximately 10:45 AM and was joined by Naira Spry (I1). Entrance interview was conducted and the reason for the visit was explained. Beginning at 09:48 AM the LPA, along with facility staff #1 (S1) toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer which contained knives and other sharp objects. LPA observed an unsecured pair of scissors in a kitchen drawer. LPA notified S1, who secured the items. LPA observed a locked under-sink storage which contained cleaning chemicals. LPA observed a locked medication cabinet. LPA observed a box of unsecured supplements. LPA informed S1 who stated that the supplements belonged to the facility staff members. S1 secured the supplements at the time of the visit. LPA did not observe a fire extinguisher in the kitchen area. LPA asked S1 where the facility’s fire extinguisher was located. S1 informed LPA that the facility was in the process of moving to a new location and the fire extinguisher was recently removed and transferred to the new location. LPA informed S1 and later the Administrator that the facility is required to maintain a fully charged and serviced fire extinguisher on the facility grounds at all times as a requirement of the facility’s fire clearance. CONTINUED ON LIC 809C. KITCHEN CONT.: LPA informed the Administrator that the violation of the facility’s fire clearance is a zero-tolerance violation and an immediate civil penalty in the amount of $500 will be assessed on today’s date (05/12/2026). The Administrator expressed understanding and obtained a fire extinguisher for the facility at the time of the visit. COMMON AREAS: This included the living room/dining area, hallway, and office area. LPA observed the living room/dining area to be clean and properly furnished at the time of the visit. The living room contained a television, activities for resident use, and a fireplace that was appropriately screened and contained no tools. Additionally, the living room/dining area contained a table and adequate seating for resident use. The hallway was observed to be free from obstructions and contained storage for the facility’s linens. The office area was observed to contain a locked storage cabinet that contained facility, staff, and resident files. Additionally, the office area contained an unlocked dresser that contained the facility’s first aid kit and caregiver’s personal items which included hygiene items. The facility’s combination fire and carbon monoxide alarms were tested at 10:20 AM and were functional at the time of the visit. During the physical plant tour and file review LPA observed that the facility was experiencing a cockroach infestation evidenced by cockroaches inside facility files and near the kitchen table. LPA notified the Administrator who stated that they were aware of the problem. The Administrator stated that they had notified the landlord of the cockroach and bedbug infestation that was ongoing at the facility but the landlord of the property failed to assist in mitigating the problem. BEDROOMS: There are three (3) bedrooms in the facility; two (2) are dual occupancy resident rooms and one (1) is a single occupancy resident room. LPA and S1 toured all three (3) resident bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #3 contained a direct exit to the outdoors of the facility. LPA observed exits in the resident bedrooms and throughout the facility to contain non-functioning auditory alarms. LPA observed three (3) resident beds to contain full bed rails. During file review LPA was informed by the Administrator that no residents of the facility were on hospice. LPA informed the Administrator that 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. The Administrator expressed understanding and agreed to remove the rails from the resident’s beds. Additionally, LPA observed unsecured hygiene items throughout the resident bedrooms. CONTINUED ON LIC 809C. BATHROOMS: There are two (2) bathrooms at the facility. One (1) designated as a staff (private) bathroom, and one (1) is designated as a shared/common resident bathroom. All bathrooms were observed to be clean and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The shared resident bathroom contained a storage cabinet that contained soaps and other hygiene items, LPA observed this cabinet to be unlocked at the time of the inspection. The water temperature was initially measured to be between 138.2 and 138.9 degrees Fahrenheit, which is outside of the range required by regulation. The Administrator adjusted the temperature on the hot water heater during the visit. LPA tested the water temperature again and measured the temperature to be 117.5 degrees Fahrenheit which is in compliance with regulation. During the physical plant tour LPA was informed by S1 that the bathroom attached to bedroom #3 was utilized as a staff only bathroom. LPA informed S1 and the Administrator that no bedroom of a resident shall be used as a passageway to another room, bath or toilet. The Administrator expressed understanding and agreed to utilize this bathroom as a resident bathroom. OUTDOOR SPACE: The facility has one (1) emergency exit gate located at the front of the facility; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. The backyard of the facility contained a laundry room which contained the facility’s washer and dryer along with laundry chemicals and pesticides. LPA observed this room to be unlocked at the time of the visit. Additionally, LPA observed a locked storage shed and a separate dwelling with its own address that is not associated to the facility. During the physical plant tour LPA was informed by S1 and later the Administrator that the back house (7827 Simpson Ave, North Hollywood, CA 91605) was being operated as an “Independent Living Facility”. LPA was informed by S1 that five (5) individuals were residing in the back home. LPA observed that the individuals residing in the back home had access to the clients in care at the licensed facility. During file review LPA observed one (1) individual from the back home enter the facility and ask S1 for a meal. LPA informed the Administrator that since the tenants of the back home had access to the clients in care, individuals that resident in the back home require fingerprint clearance and association to the facility. The Administrator stated that they were aware of this requirement as one (1) of five (5) individuals had fingerprint clearance and association to the facility at the time of the inspection. The Administrator stated that all individuals in the back house had resided at the location for more than one (1) week. CONTINUED ON LIC 809C. RECORD REVIEW: Record review began at 10:40 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Two (2) staff files were reviewed. One (1) staff file was observed to be missing up to date trainings. LPA requested to review Staff #2’s (S2) file but was informed by S1 that S2 was recently hired and did not have a completed staff file. LPA informed the Administrator that personnel records must be maintained on the licensee, Administrator and each employee. The Administrator expressed understanding and agreed to submit a completed staff file for S2 to Community Care Licensing Division (CCLD). During record review LPA observed that I1, S2, and four (4) individuals residing in the back house were not fingerprint cleared/associated to the facility. LPA informed the Administrator that prior to employment or initial presence in the facility individuals subject to a criminal record review shall obtain a California clearance or a criminal record exemption as required by law or Department regulations. LPA informed the Administrator that a civil penalty in the amount of $3000 is being assessed on today’s date for six (6) individuals without appropriate criminal record clearance. (6 Individuals x $100 /day x 5 days [1st offence, 5 day maximum] = $3,000 total penalty). The Administrator expressed understanding and agreed to obtain criminal record clearance and associate all individuals with access to the clients to the facility. Five (5) resident files were reviewed. Four (4) resident appraisal needs and services plan (ANS) were not updated annually. LPA informed the Administrator that, appraisals shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first. The Administrator expressed understanding and agreed to submit updated ANS for the identified residents to CCLD. One (1) resident file was observed to be missing all documentation except their Centrally Stored Medication and Destruction Record Sheets (CSMDRs). LPA informed the Administrator who stated that the resident was looking to relocate from the facility and paperwork had not been completed. LPA informed the Administrator that the facility shall ensure that a separate, complete, and current record is maintained for each resident in the facility. The Administrator expressed understanding and agreed to submit a complete resident file for the identified resident to CCLD. MEDICATION REVIEW: Medication review began at approximately 12:30 PM. Medications for three (3) of five (5) residents were observed. All observed CSMDRs were observed to contain incorrect and out of date information including: dates filled, prescription numbers, names of medications, and dosage of medications. CONTINUED ON LIC 809C. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are to be conducted quarterly; the facility’s last emergency disaster drill was conducted on 04/02/2025 which is outside of the range required by regulation. The facility’s emergency disaster plan contained outdated information pertaining to the emergency equipment the facility had on hand. Both the infection control plan and the emergency disaster plan were not reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that the staff treat them well and are attentive to their needs. The residents interviewed had no concerns with the facility. LPA interviewed one (1) staff member. The staff member interviewed was knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA was informed that the facility would be transferring their location to a new home in Northridge. LPA informed the Administrator that they were not notified of the change of location. The Administrator stated that they had been in contact with the Centralized Application Bureau throughout the process. LPA was notified that the landlord had refused to renew the lease on the property and the facility’s control of the property lapsed on 05/01/2026. The Administrator informed LPA that the landlord had approved a two (2) week extension and the facility would remain in control of the property until 05/16/2026. LPA informed the Administrator that this should have been reported to CCLD along with other incidents which threatened the health, safety, and welfare of the residents in care. The Administrator stated that CCLD was notified. LPA reviewed the facility’s file and observed the last submitted incident report was received in February 2025. The Administrator did not provide LPA with proof of incident report submissions at the time of the visit. LPA notified the Administrator that any incident which threatens the welfare, safety or health of any resident shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, emergency disaster plan, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited and civil penalties assessed. (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, May 12, 2026

The state marks this report as 17 pages; the online copy we transcribed has 16. You can request the full file from the county licensing office.

Allegation investigated: Staff did not ensure that resident received proper wound care while in care Facility retained a resident with a higher level of care need Staff did not ensure resident’s hygiene needs were met while in care Staff did not ensure that resident’s toileting needs were met while in care

Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation with the purpose of delivering findings for the allegations listed above. Upon arrival, LPA met with staff. Administrator was contacted via telephone and LPA explained the reason for the visit. Licensee Tigran (Tony) Gevorgyan arrived at 01:05PM. Entrance interview conducted. During an initial complaint visit conducted on 05/21/2024, LPA Emily Peraldi conducted an interview with Staff #1 at 11:09AM, requested copies of pertinent documents at 11:20AM, and the LPA, along with staff conducted a physical plant tour at 12:24PM. On 06/05/2025, LPA Dulek conducted a subsequent complaint visit, during which LPA toured the facility with staff at 10:17AM, interviewed Administrator via telephone at 10:20AM, staff at 10:41AM, conducted resident interviews between 10:49AM - 11:00AM, and LPA interviewed Licensee at 11:02AM. The LPA requested additional documents for Resident #1 (R1) to be emailed to the Report Continued on LIC 9099-C (p.2) Unsubstantiated LPA upon receipt from the hospice company. LPA also obtained hospital records for R1. Throughout the course of the investigation, LPA Dulek reviewed all documents received. The following was then determined: Allegation “Staff did not ensure resident received proper wound care while in care:” It was alleged that R1 had multiple wounds on their face and head and was not receiving proper treatment for these wounds. Record review revealed that prior to moving into the facility, R1 had lived alone and was independent. On 04/16/2024, R1 was found in their private home on the floor and was taken to the hospital. Upon admit to the hospital, R1 was “critically ill” and suffering from multiple health conditions, both acute and ongoing. Records indicate that upon admit, R1 had an ulcerated dermal mass at the right preauricular region (in front of R1’s right ear,) which appeared to be squamous cell carcinoma or basal cell carcinoma. R1 also had a right parotic exophytic mass (a mass on R1’s neck near their ear, growing outward,) which also appeared to be cancerous. Due to R1’s age and prognosis, no surgical interventions or treatments for these masses were indicated and instead, medical professionals discussed both palliative care and hospice care options with R1. While in the hospital, R1 was diagnosed with metastatic melanoma, which remained untreated while in the hospital. R1 was discharged from the hospital on 05/03/2024, with no ongoing treatment plans indicated for these identified masses. R1 was admitted to hospice care on 05/05/2024 with a diagnosis of melanoma. According to staff interviewed, the hospice nurse provided medical treatment to R1 as needed and documented treatment in R1’s hospice care plan. Record review revealed that R1’s alleged “wounds” were not pressure injuries or surgical wounds at all but were carcinoma masses instead. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. Allegation: “Facility retained a resident with a higher level of care need:” The complaint alleges that the facility retained R1 even though R1’s needs exceed assistance available under Title 22 regulations. Initially hospital records indicated “will need eventual hospice SNF (Skilled Nursing Facility) placement." However, on 04/25/2024, hospital doctors ordered R1 to be discharged to board and care and hospice. It was confirmed on R1’s medical records that R1 was discharged to the facility on 05/03/2024 at 04:20PM and had an order for hospice care. However, R1 refused to sign papers admitting them to hospice care prior to discharge from the hospital and stated, “not today.” R1’s hospital discharge Report Continued on LIC 9099-C (p.3) summary dated 05/03/2024 indicates R1 was “determined to be medically stable for discharge to board and care with tentative plan to initiate hospice.” R1’s physician’s report dated 05/03/2024 indicates that R1 did not require assistance with all activities of daily living, nor did it indicate diagnoses of any other restricted or prohibited health conditions. R1’s physician indicated that R1 was non-ambulatory at that time. Interview with Administrator and record review revealed that R1 was admitted to hospice care on 05/05/2024 with a diagnosis of melanoma. LPA was unable to interview R1 related to the allegation as R1 was hospitalized on 05/12/2024 and passed away while in the hospital. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. Allegation “Staff did not ensure resident’s hygiene needs were met while in care:” It was alleged that on 05/12/2024, R1 was observed to “not have been bathed in days.” LPA interviewed both staff and residents related to hygiene needs. All persons interviewed stated that when a resident is on hospice, the hospice agency sends a shower/bath aide 2-3 times a week as ordered for the resident. As R1 was on hospice care as of 05/05/2024, hospice would have been responsible for bathing R1. Staff also indicated that they offer a sponge bath between scheduled showers, if the resident requires additional care. In the case of R1, R1 only resided at the facility for 9 days, however, staff interviewed believe hospice did shower R1 during that time. Although LPA was unable to interview R1, other residents interviewed felt their hygiene needs are met and had no concerns related to their shower/bathing needs. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. Allegation: “Staff did not ensure that resident’s toileting needs were met while in care:” The complaint alleged that on 05/12/2024, R1 was observed to be “covered in feces.” LPA interviewed both staff and residents, who indicated residents that require incontinence care are checked every 2 hours and changed as needed during the day and night. During LPA’s visits, there were no observed incontinence odors present nor any indication that the residents’ toileting needs are not met. Residents felt the staff do a sufficient job checking on them and meeting their needs. LPA was unable to interview R1 related to the Report Continued on LIC 9099-C (p.4) allegation, as R1 was hospitalized as of 05/12/2024, prior to the complaint being filed. LPA confirmed that R1 passed away in the hospital. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. No citations issued. Exit interview conducted. A copy of today’s report was provided.the state’s words, verbatim · CDSS document, Jun 27, 2025 · control 29-AS-20240520124009

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:27 AM. LPA met with facility staff and contacted the facility Administrator Naira Spry. The Administrator stated that they are unable to come to the facility during today’s inspection, but the Owner/Licensee Representative Tigran Gevorgyan (LIC) would be arriving to conduct the visit. LIC arrived to the facility at approximately 10:00 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:30 AM the LPA, along with facility staff #1 (S1) toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: This includes the living room/dining area, hallway, and office area. LPA observed the living room/dining area to be clean and properly furnished at the time of the visit. The living room contains a television, activities for resident use, and a fireplace that is appropriately screened and contains no tools. Additionally, the living room/dining area contained a table and adequate seating for resident use. The hallway was observed to be clean and free from obstructions. The office area was observed to contain a locked storage cabinet that contained facility files. Additionally, the office area contained an unlocked storage dresser that contained the facility’s first aid kit and caregiver’s personal items. LPA observed this dresser to contain unsecured resident medications including prescription inhalers, ointments, and staff supplements. Facility staff secured all medications at the time of the visit. The facility’s combination fire and carbon monoxide alarms were tested at 01:02 PM and were functional at the time of the visit. Continued on 809C. BEDROOMS: There are three (3) bedrooms in the facility; two (2) are dual occupancy resident rooms and one (1) is a single occupancy resident room. LPA and S1 toured all three (3) resident bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #3 contains a direct exit to the outdoors of the facility. KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects. LPA observed a fire extinguisher to be purchased on 05/21/2024. The kitchen contained a locked under-sink storage containing cleaning chemicals. LPA observed two unlocked kitchen drawers to contain gardening shears and a large sharp two-pronged fork. Facility staff secured the objects during the inspection. BATHROOMS: There are two (2) bathrooms at the facility. One (1) designated as a private bathroom, and one (1) is designated as a shared/common resident bathroom. All bathrooms were observed to be clean and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The shared resident bathroom contained a locked storage cabinet that contained soaps and other hygiene items. The water temperature was initially measured to be between 127.2 and 128.1 degrees Fahrenheit, which is outside of the range required by regulation. LIC adjusted the temperature on the hot water heater during the visit. LPA tested the water temperature again and measured the temperature to be 107.8 degrees Fahrenheit which is in compliance with regulation. OUTDOOR SPACE: The facility has one (1) emergency exit gate located at the front of the facility; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. The backyard of the facility contained a locked laundry room. The laundry room contained the facility’s washer and dryer along with laundry chemicals. Additionally, LPA observed a locked storage shed and a separate dwelling with its own address that is not associated to the facility. Continued on LIC 809C. RECORD REVIEW: Record review began at 10:20 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Three (3) staff files were reviewed. All staff files contained all required documents and trainings. Five (5) resident files were reviewed. Four (4) resident admission agreements were observed to be incomplete and missing signatures and/or the rates charged for basic services. LPA informed LIC, three (3) residents were self-responsible and completed the admission agreements during the inspection. LIC stated that the remaining admission agreement would be completed no later than 05/16/2025. MEDICATION REVIEW: Medication review began at 11:50 AM. Medications for five (5) of five (5) residents were observed. Four (4) of five (5) resident’s Centrally Stored Medication and Destruction Record Sheets (CSMDR) were observed to contain incorrect and out of date information including: dates filled, prescription numbers, names of medications, and dosage of medications. LPA reviewed five (5) resident’s Medication Administration Records (MAR). All medications were observed to be logged appropriately and the number of pills remaining in medication bottles was consistent with appropriate administration of the medications. LPA informed LIC of the inaccuracies on the CSMDRs and facility staff updated the four (4) identified resident CSMDRs to accurately reflect their prescribed medications during the visit. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 04/02/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed three (3) residents. Two (2) of the three (3) residents interviewed stated that the staff treat them well and are attentive to their needs. Two (2) of the three (3) residents interviewed had no concerns with the facility. LPA interviewed one (1) staff member. The staff member interviewed was knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. Continued on LIC 809C. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, May 2, 2025

Allegation investigated: Unlawful eviction.

Licensing Program Analyst (LPA) Erica Mosley conducted an initial 10-day complaint visit to investigate the above allegation. Upon arrival at 10:20 AM, LPA Mosley were greeted by Administrator, Tigran Gevorgyan and Designee Alisa Manukyan and informed them of the visit and the reason for the visit was explained. On 10/08/2024, the Department received a complaint regarding the following allegation, Unlawful eviction. LPA toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards and the facility is in compliance with Title 22 Regulations. Report Continued on LIC9099C... Unsubstantiated On the allegation, unlawful eviction, it is the concern of the Reporting party (RP) that the facility is refusing to accept Resident (R1) back into care after being released from the hospital and did not issue R1 a thirty (30) day eviction notice. To investigate this complaint, LPA conducted in person interviews with Administrator, Designee, staff, and a telephonic interview with R1’s Responsible Party (RP) from 10:25am – 11:50am. The LPA reviewed records, including unusual incident/injury reports submitted dated 09/24/2024 and 09/28/2024, and obtained pertinent documents to the investigation. Interviews with Administrator and Designee revealed that R1 moved into the facility 09/23/2024 and less than 24 hours of residing at the facility became combative and aggressive towards staff. Facility contacted R1’s RP on 09/24/2024 and was advised to call 911. R1 was transferred to the hospital and was placed on a 51/50 hold. On 09/28/2024 R1 was discharged from the hospital and the facility accepted the resident back. R1’s RP was at the facility when R1 returned. R1 continued to have combative behavior towards staff and the RP called 911. R1 was taken to the hospital again on 09/28/2024 and placed on another 51/50 hold. During the interview with the RP, they stated they gathered all R1’s belongings and notified the facility that R1 would not return, as higher level of care was needed. RP stated R1 was not evicted from the facility, and they initiated the relocation. During the interview with the Administrator, they stated that they would have accepted the resident back upon discharge, but the RP had already stated R1 was not going to return and advised the hospital of this. During the inspection, the LPA did not observe any of R1’s personal belongings in the facility. Based on information obtained, there is insufficient evidence to support the allegations occurred. Therefore, the allegation the facility issued an unlawful eviction is deemed unsubstantiated at this time. Exit interview conducted. A copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 9, 2024 · control 29-AS-20241008153859

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 10:35 a.m., the LPA met with staff and explained the reason for it visit. At 11:06 a.m., the Administrator Tigran Gevorgyan and staff, Alisa Manukyan arrived at the facility. RECORD REVIEWS: Between 11:15 a.m. and 12:10 p.m., the LPA conducted a file review for all four (4) residents. Resident records were reviewed for, but not limited to care plans, medical assessments, admissions agreement, consent forms. The following was noted: Two (2) out of four (4) residents did not have a signed physician’s report/ medical assessments. The LPA had a discussion with the Administrator regarding the physician report/ medical assessments for Resident #1 and Resident #2. At 12:24 p.m., the LPA, along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. During the time of the visit, the LPA conducted interviews with two (2) out of four (4) residents. BEDROOMS: The facility is a single-story residential home with three (3) bedrooms for resident use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: The facility has two (2) bathrooms for resident's use. Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats/ materials. At 12:26 p.m., hot water measured between 109.1 and 112.2-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. Continued on LIC-809-C. KITCHEN: The LPA observed the kitchen and dining area. Knives are stored in a locked drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 12:35 p.m., hot water measured at 106.0-degree Fahrenheit. Cleaning solutions are locked underneath the kitchen sink. Medications are stored in a locked kitchen cabinet. First aid kit is located inside the kitchen area. OUTDOOR SPACE: At 12:30 p.m., the LPA observed the back patio which has a covered outdoor area for resident use. The property is gated. Passageways were free and clear from obstruction. There are no bodies of water on the premises. A laundry area is attached to the dwelling and is equipped with a washer and dryer. Detergents and cleaning supplies are stored inside the locked laundry storage area. On the property there is one (1) detached storage unit, one (1) locked storage shed and a detached second dwelling in the back, which is not licensed. The LPA had several conversations with the Administrator regarding the second dwelling and reminded the Administrator not to accept anyone who requires care and supervision. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguishers to be fully charged and last purchased on 05/21/2024. At 12:36 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. The LPA observed cameras in the common areas. There is an office area that is divided by sliding doors and it’s marked for employees only. Administrator certificate is current and valid until 07/16/2025. Due to time constraints the LPA will return to complete the annual at a later date. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8 and California Health and Safety Code the following deficiency was cited (refer to LIC 809-D). Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 21, 2024