Miracle Assisted Living Facility

Type of visit: Case Management - Other

Licensing Program Analyst, Huma Rahimi arrived on 03/10/2026 for an unannounced inspection to follow up on a substantiated allegation of complaint investigation. On March 14, 2022, the Department concluded a complaint investigation regarding the following allegation: “Resident #1 (R1) developed multiple pressure injuries while in the licensee’s care.” The licensee was cited for California Code of Regulations (CCR) 87615(a)(1) Prohibited Health Condition, CCR 87616(a) Exception for Health Conditions, and CCR 87464(f)(1) Basic Services. At the time of the complaint visit on March 14, 2022, an immediate civil penalty of $500 was issued, and the licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code § 1569.49(f). The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code Section 15610.67 defines serious bodily injury as “an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to hospitalization, surgery, or physical rehabilitation.” This is evidenced by the Licensee/administrator and staff failed to follow hospital/home health instructions to reposition R1 which resulted in the pressure injuries worsening. Continue on LIC 809C Today, 03/10/2026, the Department will be issuing a civil penalty per Health and Safety Code § 1569.49(f) for a violation that the Department determines as serious bodily injury in the amount of $10,000. However, since an immediate civil penalty of $500 was previously issued on March 14, 2022, the amount of the civil penalty issued today will be $9,500. Exit interview conducted. A copy of the report issued. Appeal rights provided. Rima Agaronyan and signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.the state’s words, verbatim · CDSS document, Mar 10, 2026

Type of visit: Required - 1 Year

At 1:15pm, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at the facility to conduct a required unannounced annual inspection. Upon arrival, LPA met with the Administrator Gayane Aghabekyan who granted access to the facility. LPA explained the reason for the visit. Entrance interview conducted. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: Facility maintains a temperature of 73°F. Facility is licensed for capacity of six (6) residents, of which six (6) may be Non-Ambulatory and one (1) bedridden. Facility also has a hospice waiver for five (5) residents. There are four (4) bedrooms designated for resident’s use, and one staff room. LPA observed all bedrooms to be appropriately furnished with a bed, nightstand, a chair, extra linen and have appropriate lighting. The facility also has three (3) bathrooms. LPA observed all bathrooms have soap; paper towels and extra towels and linens were readily available. The hot water temperature measured 117.3F. There are grab bars for each toilet and shower, bathrooms have non-skid mats. All trash cans in bathrooms had fitted lids to protect them from cross contamination. The facility has alarms on all exit doors. At 2:10pm, LPA observed medications, residents and staff files are kept inside the commercial cabinet located in the office area next to the entrance and observed to be inaccessible to residents in care. There is a complete first-aid kit in the cabinet with all required supplies and with the first aid manual. The facility has alarms on all exit doors. Continue on LIC809-C The fire extinguisher is located in the kitchen and was last purchased on 9/2/2025. LPA observed there to be sufficient stock of one-week perishable foods and two-day non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Laundry is in a separate locked area located in the patio. The washer/dryer appears to be in good condition. All chemicals and detergents are kept inaccessible to residents in care. Smoke detectors and carbon monoxide monitors were tested and observed to be functional. The back of the facility has sufficient yard space. At 10:05am, LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There is a swimming pool that is fenced all around with a gate that is approximately 5 feet high. You will need a key to gain access to the swimming pool as it is kept locked at all times. LPA discussed the importance of maintaining care and supervision to meet the needs of residents. Between 1:45pm to 3:00pm, LPA reviewed records of five (5) residents and five (5) staff. Resident and staff records appeared to be complete and updated. LPA observed Administrator certificate renewed on 10/1/2026. Annual fee is paid in full. LPA collected Certificate of Liability Insurance, LIC500, and LIC9020. No citations were issued during this visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Oct 23, 2025

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an unannounced Case Management-Legal/Non-compliance visit. LPA met with Rima Agaronyan - Administrator Designee, who granted access to the facility and informed that due to health condition facility Administrator won't be able to join the visit. LPA explained the reason for the visit, and conducted entrance interview. On 7/30/2024, a Non-Compliance Conference (NCC) was held at the Regional Office (RO) to discuss complaint # 31-AS-20211116143735 and other facility deficiencies. As a result of that NCC, the facility was placed on a two-year compliance plan. At that time, the Regional Manager (RM) and Licensing Program Manager (LPM) advised the Administrator should strive to remain in full compliance Relevant Title 22 Regulations. The purpose of today’s visit is to conduct thorough inspection to ensure compliance. LPA conducted a physical plant tour to ensure the health and safety of the clients and that the physical plant was in compliance with CA Title 22 Regulations. Today’s focus was staff and resident records for accuracy, required documentation for Exception Requests, Residents health condition. LPA was informed that the facility currently has five (5) residents. The facility also has three (3) staff members and LPA checked the Licensing Information System (LIS) and observed that all staff members are associated with this facility and the fingerprints are cleared. No deficiency cited during todays Case Management visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Sep 25, 2025

Type of visit: Case Management - Legal/Non-compliance

At 9:30am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an unannounced Case Management- Legal/Non-compliance visit. Upon arrival LPA met with the Caregiver Gayane Nersesyan, showed the department badge and explained the reason for the visit. Administrator Gayane Aghabekyan arrived shortly after and helped with physical plant walkthrough and resident/staff files. Entrance interview conducted. On 7/30/2024, a Non-Compliance Conference (NCC) was held at the Regional Office (RO) to discuss complaint # 31-AS-20211116143735 and other facility deficiencies. Attendees included Regional Manager, Angela Whittaker; Licensing Program Manager, Eva Miller; Licensing Program Analysts Perchui Milena Khurshudyan, Mariana Agban, Licensee Bagrat Vahramyan, Administrator Gayane Aghabekyan, and Administrator Designee Rima Agaronyan. As a result of that NCC, the facility was placed on a two-year compliance plan. At that time, Regional Manager (RM) and Licensing Program Manager (LPM) advised the Administrator should strive to remain in full compliance Relevant Title 22 Regulations. The purpose of today’s visit is to conduct thorough inspection to ensure compliance. LPA conducted a physical plant tour to ensure the health and safety of the clients and that the physical plant was in compliance with CA Title 22 Regulations. Today’s focus was staff and resident records for accuracy, required documentation for Exception Requests, Residents health condition. Continue on LIC809-C At approximately 10:15am, LPA requested staff and resident records. LPA was informed that the facility currently has five (5) residents and five (5) staff members. During today's visit LPA observed two (2) staff members on duty. LPA also checked the Licensing Information System (LIS) and observed that staff members/Caregivers are associated with this facility and the fingerprints are cleared. LPA interviewed all residents, and all residents confirmed they feel happy, they love the facility, and have no concerns regarding food, staff and/or the care they receive in the facility. Resident Files: At 11:00am LPA conducted resident and staff records review. The following was observed. Five (5) out of five (5) residents’ files were updated and complete. All required forms were present. Staff Files: The Administrator stated that the facility currently has five (5) staff members. LPA observed all files were complete and updated. Medication: LPA checked centrally stored medications stored locked inside the commercial cabinet located in the office area. All medications have Physician’s orders. Facility was in compliance, thus, no deficiencies were identified and issued during today’s visit. Exit interview conducted, copy of this report signed and delivered.the state’s words, verbatim · CDSS document, May 16, 2025

Type of visit: Required - 1 Year

On 10/31/24 at 9:45am an unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena Khurshudyan . Upon arrival, LPA met with the caregiver Susan Sahakyan, who granted access to the facility. LPA explained the reason for the visit. Shortly after the Backup-Administrator, Rima Agaronyan arrived and helped with physical plant tour and staff/residents files. During today's visit, LPA conducted a physical plant walk through, at approximately 10:20am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22. The following was observed: Facility is licensed for capacity of six (6) residents, of which six (6) may be Non-Ambulatory and one (1) bedridden. Facility also has a hospice waiver for five (5) residents. There are five (5) bedrooms in the facility of which four (4) bedrooms designated for residents’ use. Bedrooms are appropriately furnished and have appropriate lighting. There are three (3) bathrooms in the facility. LPA observed bathrooms have soap, paper towels and hand washing signs. The hot water temperature measured at 10:45 to be 114°F. Extra towels and linens were readily available. There are grab bars for each toilet and shower, bathrooms have non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination. The facility has alarms on all exit doors. Centrally stored medications are locked in the cabinets located in the office area right side of the entrance. PRN medications have written orders from a physician. The facility serves residents with dementia and facility has trained staff to meet the needs of residents who are diagnosed with dementia. Potentially dangerous items are kept inaccessible to residents in care. Facility has 2 staff for AM shift and 1 awake caregiver for PM shift. Continue on LIC809-C LPA observed the kitchen area, there was sufficient stock of one-week non-perishable foods and two days of perishable foods. Frozen foods are properly wrapped and stored with expiration date labels on them. Food storage and preparation areas are clean and inaccessible to pests. LPA observed knives and sharp objects were stored in a locked drawer inaccessible to residents in care. The kitchen has a working gas stove, microwave, two (2) refrigerators, and freezer. Extra emergency food was properly stored inside the storage cabinet. The common areas which include dining and living room appeared clean and were properly furnished. Temperature was comfortable it was measured at 11:20am to be 72°F. No obstructions and or tripping hazards throughout the facility found. The Facility has one (1) fire extinguisher, LPA observed it was last purchased on 9/7/2024. Laundry room is located in the separate locked area next to the patio. LPA observed all chemicals and detergents are kept locked inside the kitchen cabinet, are under supervision, and inaccessible to residents in care. Smoke detectors and carbon monoxide monitors were tested at 11:45am and observed to be functional. LPA observed a clean covered patio and backyard furniture to accommodate six (6) residents. The backyard is properly fenced. Exit areas are free of obstructions and hazards, exit gates were unlocked and easily accessible. LPA checked inside of the locked shed it was used for facility maintenance purposes. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. The facility has a swimming pool which is properly fenced and locked. There is no garage. Between 11:15am to 1:00pm, LPA reviewed records and files of six (6) residents and four (4) staff/caregivers. A review of staff and resident records appeared to be complete. Residents' files contain a signed admission agreements and a medical assessment, and all other required documentarians. A review of staff records indicates that all facility staff and who required caregiver background checks have received criminal record clearances, LPA reviewed LIC501s, LIC503s, LIC9052s, and Training and Education certificates. There are no residents with prohibited conditions residing at the facility. Continue on LIC809C At approximately 1:00pm to 1:35pm LPA observed each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. All medications are properly labeled and checked for expiration dates. First-aid has all proper items and is current. New manual is also available. Facility also provides activities to the residents. LPA observed puzzles, coloring books, crayons, and board games organized and stored inside the living room cabinet. An emergency exit plan/sketch is posted along the hallway with other posting requirements. LPA collected LIC500, LIC9020, Copy of the Administrator certificate, The Infection Control, and Certificate of Liability Insurance. Facility is in compliance with Title 22 Regulations at this time. No citations issued during this visit. Exit interview conducted and copy of this report signed and delivered to the Administrator.the state’s words, verbatim · CDSS document, Oct 31, 2024