Mary's Chateau

Allegation investigated: Staff do not meet a resident's hygiene needs Staff do not properly groom a resident

Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced initial complaint visit for the above allegations. LPA arrived at 9:33AM and met with the Administrator Mary Petikyan, who arrived at 10AM. Entrance interview conducted. Beginning at 10:03AM, the LPA and Administrator conducted a brief tour to ensure the health and safety of the residents in care, and no immediate concerns were observed. Record review at 10:07AM revealed that the complaint was created under the wrong facility address as Resident #1 (R1) resided in another facility licensed by the same Licensee. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided. Unfoundedthe state’s words, verbatim · CDSS document, Oct 1, 2025 · control 29-AS-20250923091622

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and was let into the facility by Kristina Zamkotidou, Staff. Staff contacted Mary Petikyan, Administrator via telephone and she arrived at 11:03am to conduct the visit. The reason for today's visit was explained. The facility is a single storey family home consisting of a living room, dining room, kitchen, 4 bedrooms, 3 full bathrooms and a attached garage. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN resident. Bedroom #1 is designated for bedridden use. The facility is approved for 2 hospice waivers. There are no bodies of water on the premises. During today's visit all 12 domains of the CARE Inspection Tool was reviewed, 5 resident files and 8 staff files were reviewed. A tour of the physical plant, inside and outside, was conducted. The following were observed on today's visit: The dining room, living room and kitchen are equipped/furnished with the appropriate furniture and equipment for it's designated use. Bedroom #1 and Bedroom #4 were observed with 2 hospital beds, 2 night stands, 2 lamps, 2 chairs and a shared dresser. Bedroom #1 has 2 portable closets and Bedroom #4 has a built in closet and a portable closet. The windows and outside exiting doors have blinds for privacy. The auditory devices on the doors were tested and were operational. Located inside Bedroom #4 is a private bathroom equipped continued on LIC809-C Page 2 with a shower, a sink, toilet with a riser, grab bars and a slip resistant mat. Water temperature was tested and read 109.5 degrees Fahrenheit. Bedrooms #2 and Bedroom #3 were observed with 1 hospital bed, a night stand, a lamp, a chair, a dresser and a built in closet. Bedroom #2 has an outside exiting door that leads to a ramp and is equipped with an auditory device and was operational. Located inside Bedroom #2 is a private bathroom equipped with a walk in shower, toilet, a sink, grab bars and a slip resistant mat. Water temperature was tested and read 118.9 degrees Fahrenheit. The common bathroom located by the laundry closet is equipped with a walk in shower, chair, sink, toilet, grab bars and a slip resistant mat. Water temperature taken read 114.6 degrees Fahrenheit. The laundry closet was observed with a stacked washer and dryer. Extra Linens, towels and blankets were observed in the hallway closet. The facility has current general liability insurance that meets Title 2 requirements. The garage was observed to be used for storage of incontinent products, 30 gallons of water, an extra refrigerator with meats, fruits and vegetables and emergency rations and extra wheel chairs, sofa and staff clothing. Sufficient perishable foods for a minimum of days and non-perishable foods for a minimum of 7 days were observed. The facility also maintains 2 buckets of emergency food rations. The facility has 2 fire extinguishers - one located in the dining room and one by the door to the garage. Both were purchased on 4/24/25. The first aid kit met Title 22 requirements. First aid manual was observed. The hardwired smoke detectors located inside the resident bedroom and the combination smoke/carbon monoxide detector located in the resident room hallway and the living room were tested and were operational. However, the fire rated door located between the resident rooms and living room did not shut completely. Per tour of the backyard, a table with an umbrella, chairs and wicker sofa and armchair were observed. Trash cans located along the right side of the home were observed in good condition and were tightly sealed. The front and back yard were observed to be clean of debris except for fallen leaves. continued on LIC809-C Page 3 no bodies of water were observed on the premises. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8 Exit interview was conducted, Appeals Rights discussed and a copy was provided.the state’s words, verbatim · CDSS document, Sep 16, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 11:00 a.m. Upon arrival, LPA Mosley was greeted by staff and called the administrator to inform them of the visit. The administrator arrived shortly thereafter. The LPA met with Administrator MARY PETIKYAN and explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility is a single-story family home consisting of a living room, dining room, kitchen, 4 bedrooms, 3 full bathrooms and an attached garage. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN resident. KITCHEN: The LPA inspected the kitchen/food service area at 11:17 a.m. Knives and sharps were observed in a locked cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 110.9 degrees Fahrenheit at 11:33 a.m. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 2:42 p.m., smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The facility has two (2) fire extinguishers that were observed and fully charged on 07/12/2024. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 08/02/2024. Activities were observed in the common areas. Report Continued on LIC 809C... Report Continued from LIC 809... RESTROOMS: The three (3) resident restrooms one (1) shared and two (2) private and were clean, sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured; the shared bathroom measured at 112.9 degrees Fahrenheit at 11:20 a.m. The hot water temperature in the private bathroom was measured between approximately 11:20 a.m. and 11:40 a.m. and measured at 111.8 and 115.2 degrees Fahrenheit within the required range. BEDROOMS: There are 4 (four) total bedrooms in the facility; two (2) are designated as a shared room, two (2) are designated as private resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. GARAGE/BACKYARD: The garage is maintained locked at all times. There is a washer and dryer on premises. Laundry detergent was observed in the locked garage. LPA observed an adequate amount of emergency food and water. Cleaning supplies are kept in the garage locked and inaccessible to residents in care. The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. MEDICATIONS: Medications review began at approximately 1:55 p.m. The medications are locked in a cabinet adjacent to the kitchen. Medications for six (6) residents were reviewed. Medications reviewed were found to be self administered as prescribed and documented on the centrally stored medication and destruction records. RECORDS: Resident Records were reviewed beginning at 11:49 a.m. and personnel records at 12:30 p.m. Six (6) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Report Continued on LIC 809C... Report Continued from LIC 809C... Six (6) personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INTERVIEWS: Three (3) staff interviews were conducted. Four (4) resident interviews were attempted, two (2) interviews were conducted. One (1) family member/ visitor interview was conducted at the time of the visit. No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 6, 2024