Lilos Tender Senior Care Inc. II

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Angelica Boyles conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself, and discussed the purpose of the visit with caregiver Wendy Gomez. According to the facility's license, the facility has a maximum capacity of six (6) residents, two (2) ambulatory in rooms #1 and #2, four (4) non-ambulatory in rooms #3 and #4, of which one (1) may be bedridden in room #3. The facility also has a granted waiver for hospice care for six (6) residents. LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected each room. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was comfortable and compliant. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. (Continued on LIC 809-C) (Continued from LIC 809) No pools or bodies of water were observed on the premises. Per caregiver, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and reviewed multiple staff and resident records/files. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with caregiver Wendy Gomez to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Apr 22, 2026

Allegation investigated: Licensee's staff took resident's private property.

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to commence a Complaint Investigation regarding the above allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Jose “Manuel” Hernandez-Mendez. LPA also spoke briefly with Licensee Anna Petrosyan via phone during the visit. The Complainant alleged that Licensee’s staff [Staff #1 (S1)] took resident’s [Resident #1 (R1)] private property. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] CCLD’s investigation involved an unannounced facility tour/welfare check and interviews of R1, S1, each of R1’s peers/housemates, and other pertinent facility staff and outside sources. The Department also reviewed the facility’s care records on R1. [CONTINUED ON LIC 9099-C, 1 of 2] Unsubstantiated [CONTINUED FROM LIC 9099] The Complainant claimed around 07/24/2025, S1 confiscated marijuana from R1’s bedroom table, in R1’s presence and with R1’s knowledge. The Complainant did not know the rationale for the action but made it clear that they did not suspect Licensee’s staff of taking the marijuana for personal use. Review of R1’s latest LIC602 Physician’s Report showed that while R1 was not formally diagnosed with Dementia or Mild Cognitive Impairment (MCI), their doctor indicated that R1 did have “cognitive deficits.” Per the LIC625 Appraisal/Needs and Services Plan which Licensee authored, R1 was “forgetful at times.” R1’s medication list did not include a doctor’s order/prescription for marijuana. Per LPA’s own interview of R1: R1 denied having Dementia or MCI, but they told LPA that they were sometimes forgetful. R1 stated that their responsible person (RP) typically brought them eight (8) buds of marijuana purchased from a dispensary store, at the beginning of every month, once per month. They said the RP would hand this quantity over to facility staff, who were responsible for centrally storing and handing R1 their marijuana (in smaller amounts) alongside their prescription medications. R1 said they typically consumed one (1) bud per day, and that they consumed marijuana on a consistent daily basis. When asked if R1 ever typically skipped days (i.e., if there were days in between when they didn’t consume marijuana), R1 said no; R1 said they asked for it every day without failure. Regarding the date in question, R1 denied S1 coming to their room to confiscate their marijuana. R1 instead said they personally handed three (3) buds of marijuana to S1 for temporary safekeeping but later could not get it back from S1, for unclear reasons. However, R1’s account of the incident contradicted the account they had earlier given to a credible and neutral third-party source, whom LPA interviewed. LPA denied staff ever taking or withholding any other personal possession from them. In their interview with LPA, S1 denied confiscating marijuana from R1, at any time. Interviews of multiple caregivers aligned to show: R1’s RP typically visited the facility once at the beginning of each month to deliver R1’s marijuana to facility staff for central storage. Every day, staff gave marijuana in smaller increments to R1, until this supply was depleted. (Staff’s description of the approximate quantity of marijuana which RP provided to them monthly approximated the same quantity which R1 themselves said their RP delivered.) [CONTINUED ON LIC 9099-C, 2 of 2] [CONTINUED FROM LIC 9099-C, 1 of 2] Staff unanimously reported that R1’s typical rate of consumption meant that their supply of marijuana would last until the 15th of the month in a best case scenario, but often ran out sooner. They said R1’s RP simply did not provide R1 enough marijuana to last R1 the whole month. They said on past occasions, when they repeatedly informed R1 that the supply was depleted, it was common for R1 to not believe them. LPA also interviewed each of R1’s five peers/housemates; of these, one was too disoriented to answer questions. The other four residents said the facility’s staff treated them well, and each denied staff ever trying to take away or withhold their personal belongings. Based on records and interviews, a preponderance of evidence does not exist to show that Licensee's staff took resident's private property. The allegation is therefore Unsubstantiated, and no deficiency was cited for it. An exit interview was conducted with Licensee Anna Petrosyan and Caregiver Jose “Manuel” Hernandez-Mendez. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided to Licensee during today’s visit.the state’s words, verbatim · CDSS document, Jul 29, 2025 · control 08-AS-20250725154042

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to cite a deficiency identified during a separate complaint investigation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Jose “Manuel” Hernandez-Mendez. LPA also spoke briefly with Licensee Anna Petrosyan via phone during the visit. During the facility tour, LPA observed that the facility’s two (2) fire extinguishers had not been professionally inspected/serviced since 2021. Interview of facility administrator confirmed this. (The Licensee was required to have these extinguishers professionally inspected/serviced at least annually to remain in ongoing compliance with the facility’s prior-approved Fire Clearance.) One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). A Plan of Correction was jointly developed with the Licensee. LPA also issued one (1) Technical Violation (TV) to Licensee regarding Medical Marijuana requirements as it pertains to Resident #1 (R1), and as described in CCLD’s Medications Guide for Residential Care Facilities for the Elderly (version 08/30/2021) (refer to the LIC 9102-TV page). [See LIC811 Confidential Names List for a description of R1.] An exit interview was conducted with Licensee Anna Petrosyan and Caregiver Jose “Manuel” Hernandez-Mendez. A a copy of this report, the LIC 809-D page, the LIC9102-TV page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided to Licensee during today’s visit.the state’s words, verbatim · CDSS document, Jul 29, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Jul 30, 2025

87203 Fire Safety: “All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.” This requirement was not met, as evidenced by: Based on LPA observation and manager interview, Licensee did not maintain the facility in continuous conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire. This posed an immediate safety risk to 6 of 6 residents [R1 through Resident #6 (C6)] in care.the state’s words, verbatim · CDSS document, Jul 29, 2025

Plan of correction: Licensee opted to purchase two (2) new fire extinguishers (rather the service the existing ones). Licensee agreed to send LPA a copy of the purchase receipt plus photos of both extinguishers mounted in the designated wall spots, by the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself, and discussed the purpose of the visit with Caregiver Betsabe "Besty" Florez. House manger Stephanie Molina later joined the visit. According to the facility’s license, the facility has a maximum capacity of six (6) clients of which 2 are ambulatory and four(4) non-ambulatory of which one (1) may be bedridden in room 3. This facility does not feature a secured perimeter or delayed egress doors. LPA, accompanied by licensee’s staff, toured the interior and exterior of the facility, and inspected each room. Most pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was compliant. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. (continued on 809-C) (continued 809) No pools or bodies of water were observed on the premises. Per the licensee, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and reviewed multiple staff and client records/files. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Licensee also presented proof of current/active business liability insurance Based on today's inspection LPA issued two (2) Technical Violation (TV) regarding the patio tile and admissions agreement for 2 clients ( LIC9102-TV page). An exit interview was conducted, this report was discussed with House Manager Stephanie Molina along with a copy of the Licensee/Appeal Rights (LIC 9058 01/2106) whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Apr 14, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Amy Domingo conducted an announced Pre-Licensing visit. LPA Domingo was joined by Applicant Nvard Bebekyan and granted entry into the facility. The purpose of the visit was to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. The fire inspection was completed on 02/15/24, and the facility was approved for 5 non ambulatory residents and 1 bedridden resident. During today's visit, LPA, accompanied by applicant, toured the facility inside and outside and inspected every room. The facility was found to be in good repair with no pathway obstructions. Clients' bedrooms were observed to be clean and resident accommodations included furnishings, linens and personal hygiene items; resident bathrooms were equipped with grab bars, bath mats; staff and administrative records are located in a locked office; food service including dishes, utensils, food storage and a seven day supply of non perishables and a two day supply of fresh perishables are present; toxic substances are stored locked in the garage or the office; medication storage and administration logs are located in a locked cabinet in the kitchen; first aid kit and current first aid manual are located in the office; activities, supplies and sufficient space to conduct are present; fire extinguishers are affixed with a current tag; smoke and carbon monoxide detectors are present and operable; facility posting requirements are present in a common area and the facility administrators certification is current; no pools or other body of water is present on the facility; per the applicant there are no guns, weapons or ammunition located on the property. Discussed with the applicant were continuing operation requirements, record keeping and physical plant compliance. The applicant shall contact the Centralized Application Unit (CAU) for completion of this pending facility application. An exit interview was conducted with Nvard Bebekyan, and a copy of this report and Licensee Appeal Rights (LIC 9058) were were printed and given to Nvard Bebekyan at the facility.the state’s words, verbatim · CDSS document, Apr 18, 2024