Lovebird Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Karina Vargas, and explained the reason for the visit. At approximately 9:15am, LPA took a tour of the physical plant. The facility is a one story building. Required postings were observed in the entry area. The smoke alarms and carbon monoxide are dual and interconnected. The facility has one fire extinguisher, located in the kitchen. It was purchased on 03/04/25. KITCHEN: The kitchen area is equipped with a refrigerator, oven/stove, microwave oven and sink. There is an adequate supply of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives are locked in a kitchen drawer. No cleaning supplies were observed out and accessible to the residents during the day of the inspection. BEDROOMS: There are four (4) bedrooms designated for client use. Bedroom #1 and #3 are private, while bedrooms #2 and #4 are shared. Per STD 850, only bedroom #4 has the fire clearance for bedridden. All bedrooms, utilized by the residents are furnished with beds, night stand, chairs, dresser, bedding and linen. All the bedrooms have sufficient lighting and closet space. Exit doors in resident rooms were checked to insure the auditory signal is functional. BATHROOMS: The facility has two (2) bathrooms. Bedroom #4 has it's own bathroom with a bathtub, but it is not being used for the residents. Both bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured between 107 and 109 degrees. No cleaning supplies were observed out and accessible to the residents during the day of the inspection. COMMON AREAS: These included the living room and dining room areas. The living room was observed with sufficient seating of couches and chairs. Living room is also furnished with a coffee and chess table. There is a fireplace with a screen in the living room, but it is non-operational. The key is stored and inaccessible to residents. No fireplace tools or fixtures present. The dining room table is large enough to accommodate between six (6) to eight (8). There were no visible immediate hazards. Floors were mopped and clean, and furniture were all in good repair. GARAGE: The garage is attached to the home. Door to the garage requires a key to gain access. Garage is used as extra storage space for cleaning supplies, food and emergency items. LAUNDRY ROOM: The laundry room is located in the garage. No cleaning supplies or laundry detergents were observed in the open during inspection. MEDICATIONS: The medication cabinet is located in the dining room. Cabinet has a locking mechanism to insure medications will be inaccessible to residents. OFFICE/STAFF WORKSTATION: Staff workstation is located next to the living room, by the back exit area. Resident and personnel files will be maintained in a locked filing cabinet there. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. The facility backyard has sufficient yard space. There is no swimming pool or an other bodies of water. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Dec 12, 2025

Allegation investigated: Staff did not safeguard resident's personal belongings Staff did not serve residents food free from contamination Staff is charging resident for services not rendered Staff did not provide a comfortable environment for resident

Licensing Program Analyst (LPA) Michael Cava conducted a subsequent visit to the facility to conclude the investigation regarding the above allegations. The initial visit was made by LPA Cava on 03/04/25. LPA met with staff Karina Vargas, and advised her of the complaint. Today’s investigation consisted of interviews with the administrator, staff and residents. LPA also conducted a physical plant inspection and reviewed resident records. Investigation is as follows: Staff did not safeguard resident’s personal belongings: In regards to the allegation, it was reported that the licensee did not safeguard two pairs of Resident 1’s (R1) pants, and two shirts. R1 only stayed at this facility for a month. When R1 conducted an inventory of their belongings, at the new facility that R1 moved to, these items were missing. Unsubstantiated Interviews conducted with the administrator and two (2) of two staff held between 8:00am-9:00am deny the allegation. The administrator confirmed that R1 only stayed at the facility from 11/03/24 to 12/07/23. Both administrator and staff stated that when R1 moved out, all of R1’s personal belongings were taken with them and accounted for. Approximately 9:00am-10:00am, LPA conducted a record review of R1s records. LIC 621 (Client/Resident Personal Property and Valuables) was observed on file. There were no entries for pants and shirts on the inventory. Only item listed is R1’s cell phone. Approximately 10:00am-11:00am, interviews were conducted with six (6) of six residents. These residents expressed no complaints or concerns regarding safeguarding or any loss of their property. Based on the information obtained, it could not be proven that staff failed to safeguard R1’s personal belongings. There was no evidence that R1’s pants and shirts was in R1’s possession during R1’s stay at the facility as it was not entered on the LIC 621. Therefore, the allegation is deemed Unsubstantiated at this time. Staff did not serve residents food free from contamination In regards to the allegation, it was reported that facility staff served food that was not kept in the refrigerator, or properly sealed, exposing food to contamination. As a result of this, residents got sick. Dates and times were not indicated to this allegation. Nor were there any residents or witnesses identified to corroborate the food contamination caused illness to residents. Interviews conducted with the administrator and two (2) of two staff held between 8:00am-9:00am deny the allegation. Administrator and staff had no past or current incidents of any food sicknesses to report. Staff stated food is properly sealed and labeled once served. Nothing is left open to contamination. Approximately 10:00am-11:00am, interviews were conducted with six (6) of six residents. These residents had no complaints of getting sick due to contaminated food, or and concerns that food is not being sealed properly once served. Approximately 11:00am-12:00pm, LPA conducted a physical plant inspection. LPA observed the food service/kitchen area to be clean, safe and sanitary. Perishable food in the refrigerator was observed properly sealed, labeled and nothing open and exposed. Non-perishable food kept in the kitchen pantry was observed closed, sealed and to date. Based on the information obtained, it could not be proven that staff do not keep food free from contamination. Therefore, the allegation is deemed Unsubstantiated at this time. Staff is charging resident for services not rendered In regards to the allegation, it was reported that the licensee charged R1 $800 from 10/01/24 to 10/04/24, but R1 did not move into the facility until November 2024. No documentation or records submitted to prove the $800 transaction. Interview conducted with the administrator held between 8:00am-9:00am deny the allegation. The administrator confirmed that R1 moved in 11/03/24 and moved out on 12/07/24. Administrator stated there is a pre-admission fee, but stated this fee was waived and denies that an $800 fee was charged for the periods of 10/01/24 to 10/04/24. Approximately 9:00am to 10:00am, LPA conducted a record review and observed R1 had a monthly fee of $4000. R1 did not opt for any optional services, nor was any provided to R1 during their stay. LPA observed the Pre-Admission fee was crossed out, as indicated by the administrator that this fee was never charged. Based on the information obtained, it could not be proven that R1 was charged for services not rendered. Therefore, the allegation is deemed Unsubstantiated at this time. Staff did not provide a comfortable environment for resident In regards to the allegation, it was reported that a male staff entered R1’s room unannounced while R1 was undressed. No time or date given to when this incident had occurred. Moreover, there was no names provided to identify this male staff or any witnesses identified to corroborate with this allegation. Interviews conducted with the administrator and two (2) of two staff held between 8:00am-9:00am deny the allegation. Staff state they always knock and make an announcement before entering any of the resident rooms. Approximately 10:00am-11:00am, interviews were conducted with six (6) of six residents. These residents expressed no concerns or complaints of any personal rights violations or not being provided a comfortable environment. Approximately 11:00am-12:00pm, during the physical plant inspection, LPA did not observe any personal rights violation while observing facility operations. Based on the information obtained, it could not be proven that staff are not providing residents with a comfortable environment. Therefore, the allegation is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Oct 4, 2025 · control 31-AS-20250227144825

Allegation investigated: Licensee retained a resident with a prohibited health condition.

Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegation. LPA met with the administrator, Armine Sargsian, and advised her of the complaint. It was reported that Resident 1 (R1) sustained an unstageable decubitus ulcer, resulting in hospitalization. R1 remained at the facility, with this prohibited health condition until hospitalized on 12/21/24, where R1’s wounds were noted. On 01/08/25, the complaint was referred to Investigations Branch (IB) and accepted as a full investigation, assigned IB investigator Jose Santana. On 01/13/25, LPA Cava conducted the 10 day/initial complaint visit to this allegation to conduct the health and safety inspection and gather records. IB’s investigation consisted of interviews with facility administrator, facility staff, and witnesses. IB also obtained R1’s medical records for review. The following is the results from IB's investigation: Substantiated From 01/15/25 to 02/28/25, IB conducted continuous interviews with facility administrator, staff and witnesses. These interviews reveal that R1 was not being repositioned as instructed on R1’s care plan. Further interviews with witnesses reveal that although staff took care of R1, staff did not consistently reposition R1 as instructed on their care plan. Moreover, it was also revealed that facility staff were not in communication with the home health agency regarding the progress of R1’s wound. On 01/14/25 and 01/31/25, IB received R1’s medical records and the following were reviewed: · R1 was admitted to the facility on 11/29/24. · Home Health was in place to treat R1 for Massive Associated Skin Damage (MASD). · On 12/05/24, there was some skin discoloration, but was assessed on 12/06/24 to be Stage I. · On 12/09/24, there was home health orders to provide wound care. · On 12/14/24, medical records and picture documents stage 3 in sacral area. · On 12/16/24, despite treatment from home health to address R1’s wounds, R1’s wounds progressed. · On 12/16/24 to 12/17/24, R1’s wound to the coccyx and heel progressed and was diagnosed by home health to be stage 3 and 4. · 12/16/24 to 12/20/24, with documentation and the licensee’s knowledge of the wound’s progression to the coccyx and heel, R1 was still retained at the facility for another five days. · On 12/21/24, R1 was eventually transferred to the hospital for an unrelated medical emergency. Based on the information obtained, there is sufficient evidence that the licensee retained R1 at the facility with a prohibited health condition. Therefore, the allegation is Substantiated. Citations issued on the 9099D. Licensee advised of possible Civil Penalty and Enhanced Civil Penalties (ECPs) may be assessed.the state’s words, verbatim · CDSS document, May 21, 2025 · control 31-AS-20250107135728

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: May 21, 2025

Prohibited Health Conditions- (a)Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1)Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: Licensee continued to retain R1 after their wound progressed to stage 3 and 4 wound. This posed an immediate health and safety risk to the resident in care.the state’s words, verbatim · CDSS document, May 21, 2025

Plan of correction: As POC, the licensee will hold training to address this section of the regulations. As proof training was held, licensee will submit a copy of the attendance log, training topic with regulations, and date that this training was held by June 4, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: May 21, 2025

Incidental Medical and Dental Care- The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Licensee failed to transfer R1 to a higher level of care once R1's wounds progressed to stage 3 and 4. This posed an immediate health and safety risk to the resident in care.the state’s words, verbatim · CDSS document, May 21, 2025

Plan of correction: As POC, the licensee will hold training to address this section of the regulations. As proof training was held, licensee will submit a copy of the attendance log, training topic with regulations, and date that this training was held by June 4, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Armine Sargsian, and explained the reason for the visit. At approximately 12:45pm, LPA took a tour of the physical plant. The facility is a one story building, licensed to serve residents age 60 years and over. Required postings were observed in the entry area. The smoke alarms and carbon monoxide are dual, hardwired and interconnected. The facility has one new fire extinguisher, located in the kitchen. It was purchased on 03/03/25. KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, oven/stove, microwave oven and sink. There was an adequate supply of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives are locked in a kitchen drawer. No cleaning supplies were observed out and accessible to the residents during the day of the inspection. BEDROOMS: There are four (4) bedrooms designated for client use. Bedroom #1 and #3 are private, while bedrooms #2 and #4 are shared. Per STD 850, only bedroom #4 has the fire clearance for bedridden. All bedrooms, that are utilized by the residents are furnished with beds, night stand, chairs, dresser, bedding and linen. All the bedrooms have sufficient lighting and closet space. Exit doors in resident rooms were checked to insure the auditory signal is functional. BATHROOMS: The facility has two (2) bathrooms. Bedroom #4 has it's own bathroom with a bathtub, but it is not being used for the residents. Both bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 111 degrees. No cleaning supplies were observed in the open, or accessible to the residents during the day of the inspection. COMMON AREAS: These included the living room which is equipped with a couch, three chairs, television, a coffee table and chess table. There is a fireplace with a screen but is non-operational. The key is stored and inaccessible to residents. No fireplace tools or fixtures present. The dining room table is large enough to accommodate between six (6) to eight (8). There were no visible immediate hazards. Floors were mopped and clean, and furniture were all in good repair. GARAGE/LAUNDRY ROOM: The garage is attached to the home. The laundry room is located in the garage. Door to the garage has an alert to notify staff that the entry door to the garage is open. No cleaning supplies observed, or will be kept in the garage. Garage is also used as extra storage space for PPE supplies and emergency water. MEDICATIONS: The medication cabinet is located in the dining room. Cabinet has a locking mechanism to insure medications will be inaccessible to residents. OFFICE/STAFF WORKSTATION: Staff workstation is located next to the living room, by the back exit area. Resident and personnel files will be maintained in a locked filing cabinet there. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. The facility backyard has sufficient yard space. There is no swimming pool or an other bodies of water. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Mar 4, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with the applicant representative and administrator, Anna Petrosyan and Armine Sargsian. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on August 9, 2023. A fire clearance was approved on September 19, 2023 for five (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six. The applicant is also requesting a hospice waiver to retain six (6) residents. The smoke alarms and carbon monoxide detectors are dual and hard wired. The facility has one new fire extinguishers that was purchased on September 12, 2023. It is located in the kitchen A tour of the physical plant was initiated at approximately 1:00pm and the following was observed: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. There was an adequate supply of nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives were observed locked in a kitchen drawer. BEDROOMS: There are four (4) bedrooms designated for client use. Bedroom #1 and #3 are private, while bedrooms #2 and #4 are shared. Per STD 850, bedroom #4 only, has the fire clearance for bedridden. The applicant furnished all the resident bedrooms with beds, night stand, chairs, dresser, bedding and linen. The bedrooms also have sufficient lighting and closet space. BATHROOMS: The facility has two (2) bathrooms. Bedroom #4 has it's own bathroom with a bathtub, but it won't be utilized for residents. Both bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 105 degrees. COMMON AREAS: These included the living room which were equipped with a couch, chair, television, and table. There is a fireplace with a screen but will be non-operational. The key will be stored and inaccessible to residents. No fireplace tools or fixtures present. The dining area has a large dining room table to accommodate between six (6) to eight (8). There were no visible immediate hazards. GARAGE/LAUNDRY ROOM: The laundry room is located in the garage. Door to the garage has an alert to notify staff that the entry door to the garage is open. No cleaning supplies observed, or will be kept in the garage. The washer/dryer are brand new. Garage will also be used as extra storage space for equipment, PPE supplies, and emergency water. MEDICATIONS: The medication cabinet is located in the dining room. Cabinet has a locking mechanism to insure medications will be inaccessible to residents. OFFICE/STAFF WORKSTATION: Staff workstation is located by the exit to the backyard.. Resident and personnel files will be maintained in a locked filing cabinet there. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. The facility backyard has sufficient yard space. There is no swimming pool or bodies of water. In addition to the Pre-Licensing inspection, a Component III power point presentation was also held between/approximately 12:20pm and 1:00pm Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 13, 2023