Lindley Residential Care

Type of visit: Required - 1 Year

On 6/3/2026 at approximately 1:30pm, Licensing Program Analyst (LPA), Perchui Milena Khurshudyan conducted an unannounced annual visit to the facility. LPA was greeted by the caregiver and stated the reason for their visit. The Licensee/Staff, Hamazasp Khudoyan arrived shortly after to assist with today’s visit. LPA asked for the census, Staff/Resident Roster, and Liability Insurance. LPA conducted a physical plant tour at approximately 2:00 PM and the following was noted: The facility is a single-story building with six (6) bedrooms, six (6) bathrooms. The facility is currently occupying four (4) residents. There is no designated staff room. The facility has an approved fire clearance for six (6) non-ambulatory residents of which one (1) may be bedridden. Hospice waiver approved for four (4). All bedrooms are approved for bedridden, however, 1 at a time. There are three licensed RCFEs on the property. Common areas: The living room and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 72°F. LPA observed two (2) fire extinguishers located throughout the facility and dated 1/7/2026. LPA observed required postings such as Long-Term Care Ombudsman, Emergency Disaster Plan, and Personal Rights alongside the entrance leading towards the kitchen. A working telephone was observed. Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. Knives/sharps were observed to be kept in a locked box, placed on the kitchen countertop. The cleaning solutions/toxins were observed to be kept under the sink, inside a locked cabinet. Kitchen appliances were observed to be working and in proper condition. (continued on LIC 809-C) Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers were observed readily available. Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations at 109.2 °F. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition. Laundry Room: The laundry room was observed to be located in the hallway, inside a separate locked laundry closet. LPA observed cleaning solutions and toxins stored inside the same closet. The laundry appliances were observed to be working and in proper condition. Garage: LPA observed garage is used as a storage. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. There is no body of water located at the facility. Medications: The medications were observed stored in a locked cabinets located near the kitchen area. LPA reviewed the Centrally Stored Medication and Destruction Records and found documentation to be complete and accurate. All PRN medications had current physician orders. LPA observed staff and resident files to be kept locked in storage cabinet located in the staff/reception desk area. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer and First-Aid Manuel. Smoke detectors and carbon monoxide observed to be working properly and were tested. Residents/Staff Records: LPA conducted a complete file review of resident records. Resident records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. There were no immediate health and safety hazards observed during the day of inspection. LPA collected LIC500, LIC9020, copy of Certificate of Liability Insurance, and copy of Administrator Certificate. LPA informed the Administrator/ Licensee to update LIC610E Emergency Disaster Form and submit the updated form to the department. No deficiency cited during today's visit. Exit interview conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Jun 3, 2026

Type of visit: Required - 1 Year

On 02/03/25, at 9:40am, Licensing Program Analyst (LPA), Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with Lead Caregiver Larisa Bobakova and disclosed the purpose of the visit. LPA spoke to the administrator Armenuhi Avetisyan via telephone. LPA asked for the census, resident, and staff files. A physical tour was conducted at 11:05 AM and observed the following: Facility is a single-story home: he Kitchen area was toured, and LPA observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. There are two (2) fire extinguishers; one (1) is located against the wall on your right-hand side towards the backyard. The other is located by the entrance of the facility with an expiration of 04/2025. There is a telephone line on the counter in the kitchen another telephone line by the entrance of the facility. There is extra, food in the kitchen pantries. The medications are locked and inaccessible to the residents in a black cabinet on your left-hand side at the entrance of the facility. The first aid kit is located on the top, black cabinet where the medication is kept. The knives are at the top of the kitchen counter on your right-side in a locked black box and inaccessible to the residents. Outside/Backyard: The outside/backyard has furniture for the residents with proper seating. The facility does have a signal system. The facility does not have a pool/body of water. There is no garage. LIC 809C-continued Bedrooms: There is a total of six (6) bedrooms and six (6) bathrooms. Three (3) bedrooms and three (3) bathrooms that are located on the right side of the facility and three (3) bedrooms and three (3) bathrooms on the left side of the facility. There are two (2) bedrooms with a private bathroom. The other four (4) bedrooms do not have a private bathrooms but there are two (2) bathrooms on the left side and two (2) bathrooms on the right side. All bedrooms and bathrooms were toured and were properly furnished and have appropriate bedding, linens, toiletry, and lightning. The bathrooms have proper toiletry and grab bars. The bathroom temperatures of the water are within regulations reading at 114-117 degree Fahrenheit. There is two (2) pantries on your right side with extra linen and there is one (1) pantry on your left side with extra linen and one area that has the washer and dryer with chemicals locked and inaccessible to the residents. The dining/living room area has enough seating for the residents and the staff with a large television. The house temperature is at 73-degree Fahrenheit on both sides of the facility. The smoke detector/carbon monoxide is in the hallway and is operable. Administrative: There is an annual fee that is due right now. Towards the front of the facility on your left-hand side there is a facility sketch, House Rules, Disaster Plan, Resident Rights, Rights of Resident Council, Administrator License, Wifi connection instructions, Designation of facility, Resident Infection Control Plan and the surety bond with an expiration date of 04/2025. An exit interview was conducted, no citation(s) were issued, and a copy of this report was issued.the state’s words, verbatim · CDSS document, Feb 3, 2025

Allegation investigated: Licensee did not post ombudsman program information as required by law

On 11/12/24, at 12:00pm, Licensing Program Analysts (LPAs) Gina Saucedo and Angelica Segovia arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Lead Caregiver Larisa Bobakova. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather information, conduct staff and resident interviews and deliver findings for this complaint. The investigation consisted of the following: LPAs asked for the census, requested the staff and resident roster. At 12:10pm, LPA toured the physical plant. During the tour, residents and staff were interviewed. 9099C-continued Unsubstantiated Regarding the allegation: Licensee did not post ombudsman program information as required by law. It is being alleged that the LTCOP (long term care ombudsman program) poster was given to the above facility, and it was not posted. At the time of the LPA’s visit, the LTCOP (long term care ombudsman program) poster was posted on the right side of the entrance of the facility against the wall. LPA took pictures of the LTCOP (long term care ombudsman program) poster. LPA interviewed two (2) staff and confirmed that it was given to them in September, they signed a paper that it was given to them, and they posted it immediately. LPA interviewed two (2) residents that confirmed the poster has been posted where it currently is. Therefore, based on the LPA's record reviews, staff and resident interviews the above allegation(s) above is UNSUBSTANTIATED at this time. An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the Lead Caregiver.the state’s words, verbatim · CDSS document, Nov 12, 2024 · control 31-AS-20241104152029

Type of visit: Prelicensing

On 03/06/24, at 8:25am, Licensing Program Analyst (LPA), Gina Saucedo, conducted an announced visit to the facility for purpose of a pre-licensing evaluation. An application was submitted to Community Care Licensing Division-CCLD on 08/07/2023, Initial license for a Residential Care Facility for the Elderly, 60 years and older. The requested capacity is for five (5) non-ambulatory and one (1) bedridden, total of up to six (6) residents but fire clearance does state all bedrooms are cleared for bedridden as long as it is one (1) at a time. Facility is a single-story home. Today's site visit consisted of LPA touring the physical plant at 8:45 AM inside and outside and observed the following: Bedrooms Staff: There is no bedroom designated for staff at this time. Bedrooms Residents: There is a total of six (6) bedrooms for resident use. There shall be no more than two clients per bedroom if used for non-ambulatory. All bedrooms are cleared for bedridden but only one (1) at a time. Two (2) of the bedrooms have private bathrooms. The other two (2) full bathrooms have proper grab bars and non-skid mats. The other half bathrooms also have grab bars. All the bedrooms have proper bedding, chairs, nightstands, lamps in addition to overhead lighting. LIC 809C-continued The dining/living room Resident & Staff Files: There is enough seating for staff and residents. The furniture is in good condition. The resident/staff files will be kept in a black cabinet next to the living room/dining room area on your right-hand side. Linens & Hygiene Supplies: Adequate supply of linen stored in the cabinets next to the bedrooms in the hallway. Emergency Phone Numbers, Exit Plan & Menu: The facility has a working phone number land line. Fire Extinguisher located near kitchen door on your right-hand side mounted on the wall. It is fully charged and has a date of July 2024. There is another fire extinguisher in the living room/dining room area by the entrance of the facility. Food Service: Dishes, cups, and flat ware are stored in the kitchen cupboards, inspected and in good repair. Sharps are stored on your right-side of the kitchen locked and secured in a lock box inaccessible to the residents. Food supply adequate stored in several cabinets and consists of the following: canned goods, bottles of water. The refrigerator, stove and microwave are in good condition and working. Smoke Detectors: There are smoke detectors/carbon monoxide through-out the house that were tested and work properly. They are hardwired and interconnected. Water Temperature: The water temperature was tested for the bathrooms are they are within regulation:116.-118 Fahrenheit. Pool/Jacuzzi: There is no pool/jacuzzi in the facility. LIC 809C-continued Fire clearance: Fire Clearance was approved on 02/07/2024 signed and dated. Signal system: The facility does have a signal system installed. Administration: The facility had submitted a Emergency and Disaster Plan For Residential Care Facilities For The Elderly and Infection plan. There is billboard on your left-hand side of the facility with Personal Rights of Residents, Rights of Resident by Council, Infection Control, Disaster Plan, Facility Sketch and Theft and Loss Policy. The Component III was shown to the Administrator although they have previously seen it/orientation process was completed. Structure: Overall Facility is a six (6) bedroom home with four (4) full-bathrooms and two (2) bathrooms with no shower, single-story. The home does not have a fireplace. There is one (1) washer and dryer located next to hallway which is locked and inaccessible to the residents. There is three (3) pantry areas for extra linen and other storage that are also locked and inaccessible to the residents. Pre-licensing: Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. Exit interview conducted and copy of this report issued to the administrator.the state’s words, verbatim · CDSS document, Mar 6, 2024

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: A. Avetisyan, Administrator; Hamazasp Khudoyan, Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 15, 2024