Lilos Tender Senior Care

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced case management visit while conducting a Health & Safety visit to open a complaint investigation. The LPA introduced herself, and discussed the purpose of the visit with Caregiver, Erik Mendoza. It was noted that Caregiver Mendoza had a current criminal record clearance; however, he was not associated with this facility and has been working at the facility since October 2024. During the visit, LPA discussed the purpose for the visit with Licensee, Anna Petrosyan. Record review disclosed an additional staff member currently working at the facility that was not associated with the facility. In addition, during review of facility sketch and fire clearance it was disclosed that licensee exceeded capacity for non-ambulatory status. The facility is currently licensed for five (5) non-ambulatory and one (1) ambulatory status. During today's visit, a total of six (6) non-ambulatory residents were in care. Deficiencies were cited during today's visit. Civil penalties in the amount of $1,500 were assessed for violations and are documented on the attached LIC 421. A plan of correction was developed in coordination with Licensee, Anna Petrosyan. An exit interview was conducted with Administrator Stephanie Molina. She was provided copies of this report, LIC 809D Deficiencies, LIC 421s Civil Penalty, and Licensee/Appeal Rights (LIC 9058, 03/22).the state’s words, verbatim · CDSS document, Jul 23, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e) · Plan of correction due date: Jul 23, 2026

887355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in 2 out of 7 staff were not associated to the facility roster, which poses an immediate safety risk to 6 out of 6 persons in care.the state’s words, verbatim · CDSS document, Jul 23, 2026

Plan of correction: Licensee completed the association for one of the staff members during the visit on 7/23/2026 which eliminated immediate safety risk to residents in care. Licensee agreed to associate the 2nd caregiver prior to returning to work. Licensee agreed to submit documentation to CCL by POC deadline.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87202(a)(1) · Plan of correction due date: Jul 24, 2026

87202(a)(1) Fire Clearance All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department …(1) Nonambulatory persons. This requirement is not met as evidenced by: Based on observation and staff interviews it was disclosed that licensee exceeded non-ambulatory capacy.Faciltity is licensed for 5 non-ambulatory and currently 6 residents in care are non-ambulatory. R1 was in an ambulatory room and they were condidered non-ambulatory.the state’s words, verbatim · CDSS document, Jul 23, 2026

Plan of correction: Licensee agreed to submit application to CCL to request an increase in non-ambulatory status from 5 to 6. A new fire clearance will be requested. Licensee agreed to submit the application by POC deadline of 7/24/2026

Type of visit: Prelicensing

LPA conducted a pre-licensing visit for Component III for change of location. LPA was allowed entry by the Licensee. LPA identified herself and disclosed the purpose of the visit. A comprehensive tour of the facility, both indoors and outdoors, was conducted. At the time of the visit, no residents were in care at the current facility. Residents have not been transferred from the old facility until the end of the month. The licensee agreed to contact LPA when residents move in for post-Licensing inspection. All required postings were observed in prominent locations, including the Emergency Disaster Plan, Complaint Poster, Personal Rights, and the Let-Us-No Poster. Emergency phone numbers and the Administrator’s contact information were visible. Smoke and carbon monoxide detectors were tested and found operational. Fire extinguishers were fully charged, tagged, and properly mounted. Hot water temperature was tested and measured between 105°F – 120°F. Continued on 809C The first aid kit was present and fully stocked. Medications, cleaning supplies, and sharps were observed to be securely locked and inaccessible to residents. Adequate lighting, appropriate furniture, and clean, safe conditions were observed in all rooms and common areas. Kitchen and food storage areas were inspected, and a sufficient supply of non-perishable items was present. Component III topics, including resident personal rights, medication management, reporting requirements, and staff training, were reviewed with the Licensee. The Licensee clearly understood Title 22 regulations, record-keeping requirements, and emergency procedures. LPA discussed ongoing compliance requirements and answered questions related to day-to-day operations and licensing expectations. No deficiencies were cited during this visit. The facility appears ready for licensure and may begin accepting residents upon final approval by the Department. An exit interview was conducted with the Licensee, to whom a copy of this report and the Applicant/Appeal Rights (LIC9058) were provided.the state’s words, verbatim · CDSS document, Oct 20, 2025