Mary's Chateau II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection and was let into the home by Seda Hovhannisyan, Staff. Mary Petikyan, Administrator was contacted by staff and she arrived at 11:16 a.m. 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, office, kitchen, dining room, family room, 5 bedrooms of which one is used as a staff room, 2 common bathrooms, 1 private bathroom and a detached garage located in the back of the property. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN residents. Bedroom #4 is approved for bedridden use. All 12 domains of the Inspection Care Tool were reviewed, 5 residents and 8 staff files were reviewed on today's visit and the following were observed: The living room was furnish with the appropriate seating and coffee table. The fire place was observed with a secured with fire screen. Located in the living room is a fire extinguisher purchased on 3/25/25. The second fire extinguisher is located in the family room and was also purchased on 3/25/25. The office was observed with a table, 4 chairs, a bench, a printer and a file cabinet used to store the residents' medications. The kitchen is equipped with a stove, refrigerator, microwave and a center island with bar stools. Perishable foods for a minimum of two days and non-perishable foods for a minimum of 7 days were observed. Adjacent to the kitchen is the breakfast nook furnished with a table and four chairs. Located by the kitchen is the staff bedroom furnished with a bed and has a refrigerator with additional continued on LIC809-C Page 2. perishable foods. Also located by the kitchen is the locked laundry closet that was observed with a washer and dryer and cleaning solutions on a shelf. The family room is furnished with a sectional sofa cable of seating 6 residents and a television The dining room was observed with a table and 4 chairs. The auditory device on the outside exiting door to the back yard was operational. Bedroom #1 and Bedroom #2 is each furnished with a hospital bed, a night stand, a lamp, a chair and a built in closet. Window dressings were in good condition. The auditory device in bedroom #1 was operational. Located by bedroom #1 is the linen closet containing towels, extra blankets and bath towels, hand towels and face clothes. Bedroom #3 is furnished with a hospital bed, a night stand, a lamp, a chair and a built in closet. The second bed and the required furniture was not set up as it is offered as private bedroom. Bed was observed stored in the detached garage. Bedroom #4 is furnished with 2 hospital beds, 2 chairs, 2 night stands, a built in closet, 2 lamps and a shared dresser. The room has a sliding glass equipped with a auditory device. Located inside the room is a private bathroom equipped with a shower, a toilet and a single sink. Grab bars and a non-skid mat was observed. Water temperature was tested and it read 117.3 degrees Fahrenheit. The common bathroom located in the front was equipped with a shower, a toilet and a single sink. Grab bars and non-skid mats were observed. The water temperature was tested and read 118.6 degrees Fahrenheit. The common bathroom located by the family room is equipped with a single sink, a toilet and a shower. Grab bars and non-skid mat was observed. The water temperature was tested and read 114.0 degrees Fahrenheit. The first aid kit was observed with bandages, gauze and the required tweezer, scissor and an external thermometer. A first aid manual was observed. The facility has current general liability insurance that meets Title 22 requirements. continued on LIC809-C Page 3. The hardwired smoke detectors in the bedrooms and the combination smoke/carbon monoxide detectors located in the office, living room, the hallway of the front resident rooms and in the family room were tested and were operational. Trash cans were observed to be tightly sealed. Per tour of the backyard, an umbrella for shade and a table with chairs were observed. The backyard and front yard were observed to be well maintained. No deficiencies were cited on today's visit. Exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 14, 2026

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 10:52AM and met with the Administrator Mary Petikyan. Entrance interview conducted. At 10:55AM, the LPA and Administrator conducted a tour to ensure the health and safety of the residents in care, and no immediate concerns were observed. The LPA reviewed and obtained pertinent documents at 11:03AM. Between 11:40AM and 12:49PM, the LPA interviewed four (4) residents, two (2) staff, and the Administrator. The following was then determined: Report Continued on LIC 9099-C Unsubstantiated Allegations: “Staff do not meet a resident's hygiene needs“ and “Staff do not properly groom a resident.” It was alleged that Resident #1 (R1) was left in the same pair of clothes for multiple days and that they were sometimes malodorous. Interview with four (4) residents revealed that their clothes are changed daily in the mornings and staff assist them with showers at least twice a week. Residents specified that showers typically occur on Tuesdays and Fridays. Diaper changes occur throughout the day and residents reported that they have not experienced being left in their soiled diapers for long periods of time. Four (4) out of four (4) residents reported feeling clean throughout their days, were happy with their care at the facility, and expressed no concerns with the facility’s ability to address their medical needs. Staff interviews confirmed that residents receive showers twice a week, and more if needed based on residents’ request, or if they are soiled. The Administrator stated that in addition to showers, residents receive daily wipe downs on their entire body in the mornings. Four (4) residents receive showers from the staff and one (1) resident receive showers through their Hospice Agency. Residents’ diapers are changed up to five (5) times a day with four (4) residents able to communicate their need to use the restroom. Staff stated that residents’ clothes are changed daily and can vary up to three (3) times a day depending on if the staff observe the residents’ clothes are dirty or wet from spills. In addition to this, staff wash residents’ clothes several times throughout the week. The staff and Administrator reported that residents are groomed frequently: teeth and hair brushing occur every day, shaving occurs every other day or on shower days, and haircuts are on an as needed basis. Although residents do not commonly refuse these services, the staff and Administrator acknowledged the residents’ right to refusal and respect their wishes. The Administrator stated that if a resident refuses a service, such as showers, it is typically a temporary refusal, and that staff will try again later in the day. Additionally, families have not previously refused any services on behalf of the residents, except for when the family had an existing appointment for grooming services. During today’s visit, the LPA observed the facility in a clean condition with no foul odors. The residents were each observed to have clean linens, in clean clothes, and properly groomed. Report Continued on LIC 9099-C Although the allegations may have happened or are valid, there is not sufficient evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed UNSUBSTANTIATED at this time. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Oct 1, 2025 · control 29-AS-20251001102813

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection and was let into the home by Seda Hovhannisyan, Staff. Mary Petikyan, Administrator was contacted by staff and she arrived at 10:44am 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, office, kitchen, dining room, family room, 5 bedrooms of which one is used as a staff room, 2 common bathrooms, 1 private bathroom and a detached garage located in the back of the property. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN residents. Bedroom #4 is approved for bedridden use. All domains of the Inspection Care Tool were reviewed and following was observed: The living room was furnish with the appropriate seating and coffee table. The fire place was observed with a secured with fire screen. Located in the living room is a fire extinguisher purchased on 7/12/24. The second fire extinguisher is located in the family room. The office was observed with a table, 4 chairs, a bench printer and a file cabinet used to store the residents' medications. The kitchen is equipped with a stove, refrigerator, microwave and a center island with bar stools. Perishable foods for a minimum of two days and non-perishable foods for a minimum of 7 days were observed. Adjacent to the kitchen is the breakfast nook furnished with a table and four chairs. Located by the kitchen is the staff bedroom furnished with a bed and has a refrigerator with additional perishable foods. Also located by the kitchen is the locked laundry closet that was observed with a washer and dryer and cleaning solutions on a shelf. The family room is furnished with a sectional sofa cable of seating 6 residents and a television The dining room was observed with a table and 4 chairs. Page 2 Bedroom #1 and Bedroom #2 is each furnished with a hospital bed, a night stand, a lamp, a chair and a built in closet. Window dressings were in good condition. Located by bedroom #1 is the linen closet containing towels, extra blankets and bath towels, hand towels and face clothes. Bedroom #3 is furnished with a hospital bed, a night stand, a lamp, a chair and a built in closet. The second bed and the required furniture was not set up as it is offered as private bedroom. Bed was observed stored in the detached garage. Bedroom #4 is furnished with 2 hospital beds, 2 chairs, 2 night stands, a built in closet, 2 lamps and a shared dresser. The room has a sliding glass equipped with a auditory device. Located inside the room is a private bathroom equipped with a shower, a toilet and a single sink. Grab bars and a non-skid mat was observed. Water temperature was tested and it read 116.2 degrees Fahrenheit. The common bathroom located in the front was equipped with a shower, a toilet and a single sink. Grab bars and non-skid mats were observed. The water temperature was tested and read 116.2 degrees Fahrenheit. The common bathroom located by the family room is equipped with a single sink, a toilet and a shower. Grab bars and non-skid mat was observed. The water temperature was tested and read 116.8 degrees Fahrenheit. The first aid kit was observed with bandages, gauze and the required tweezer, scissor and an external thermometer. The facility has current liability insurance that meets Title 22 requirements. The hardwired combination smoke/carbon monoxide detectors located in all the residents bedrooms, hallway, living room, office, family room were tested and were operational. Trash cans were observed to be tightly sealed Per tour of the backyard, an umbrella for shade and a table with chairs were observed. The backyard and front yard were observed to be well maintained. No deficiencies were cited on today's visit. Exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 22, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection and was let into the home by Seda Hovhannisyan, Staff. Mary Petikyan, Administrator was contacted by staff and she arrived at 10:01am 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, 2 common bathrooms, 1 private bathroom and a detached garage located in the back of the property. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN residents. Bedroom #4 is approved for bedridden use The following domains were reviewed on today's visit: Infection Control, Operational Requirements, Staffing, Personnel Records/Staffing Training, Resident Rights/Information, Planned Activities, Food Services and Incidental Medical and Dental. All 4 resident files and 6 staff files were reviewed. The following were observed: resident and staff all have health screens with the results of a TB test Admission Agreements were observed Resident and Employee Rights were observed. staff all have current first aid and CPR training. Administrator certificate expires on 8/26/24 Liability Insurance expires on 3/29/24 and meets the minimum Title 22 requirements of $1 million per occurrence and a total of $3 million per annual aggregate. Per review of Resident #3's health screen, the physician has determined that the resident is bedridden. However, Resident #3 is able to sit up, turn from side to side without assistance and transfer to wheelchair with staff assistance. The Administrator will contact the Resident #3's doctor and obtain clarification as to whether resident is considered to be non-ambulatory or bedridden. The Administrator will provide LPA Yee with an updated written status or a corrected LIC602 from the resident's physician by no later than 2/5/24. The need for citation and civil penalties will be determined once clarification has been obtained. Due to time constraints the following domains will be reviewed on a return visit: Physical Plant/Environmental Safety, Resident Records/Incident Reports, Disaster Preparedness and Residents with Special Health Needs. No deficiencies were issued on today's visit. Exit interview was conducted.the state’s words, verbatim · CDSS document, Jan 30, 2024