Mission Lake Villa

Type of visit: Office

Licensing Program Manager (LPM), Jazmond Harris and Licensing Program Analysts (LPAs), Jacqueline Shaw-Ross and Imaculada Vasquez, met with Licensee/Administrator, Anahit Mesropyan at the Riverside Adult and Senior Care Regional Office for the purpose of discussing a concern reported on July 2, 2026 regarding an unlicensed operation. Title 22 Regulations and Health and Safety Code sections were provided: Unlicensed allegations. Section 80064 Administrator Qualifications and Duties, pertaining to knowledge of and ability to comply with applicable law and regulation. Licensee agreed to cooperate with Department investigations and inspections, including at unlicensed addresses where the Department may have received allegations of unlicensed care. Licensee provided additional documentation and information regarding the unlicensed investigation. An exit interview was conducted and a copy of this report and regulations were provided to Licensee, Anahit Mesropyan.the state’s words, verbatim · CDSS document, Jul 7, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit for a required annual inspection. The LPA was greeted by the Licensee/ Administrator Anahit Mesropyan, notified her of the purpose for the visit and was allowed to enter the facility to conduct the inspection. Facility Overview: The facility is a single story building with 4 residents bedrooms, 2 bathrooms, a kitchen, a living room and a garage. There is no gated pool and there are no firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in the kitchen area inaccessible to residents. The smoke detector and carbon monoxide detector were operational. LPA observed fire extinguishers to be in compliance with the department requirements and with an expiration date of 11-16-26. LPA observed the water temperature to meet requirements at 107.7°F. Continued on LIC809-C..... Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Care & Supervision/Administration: Adequate staff were present to supervise residents during the visit. The administrator holds a current administrator’s certificate with expiration date of September 17th, 2026 and a CPR certification with the expiration date of September, 2026 Record Review and Resident/Staff Files: LPA reviewed files for two(2) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Two (2) residents' files were reviewed and contained all required documentation. LPA observed first aid kit to be available and inaccessible to the residents in care. Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the kitchen area. LPA reviewed medications for two residents, confirming that all medications were listed and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan including documentation of the last emergency drill conducted on October 22,2025, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to Licensee/Administrator Anahit Mesropyan.the state’s words, verbatim · CDSS document, Dec 5, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit for a required annual inspection. The LPA was greeted by the Administrator Anahit Mesropyan, notified her of the purpose for the visit and was allowed to enter the facility to conduct the inspection. Facility Overview: The facility is a single story building with 3 residents bedrooms, 1 staff bedroom and 2 bathrooms. There is no gated pool and there are no firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in the kitchen area inaccessible to residents. The smoke detector and carbon monoxide detector were operational. LPA observed fire extinguishers to be in compliance with the department requirements and with an expiration date of 12/2025. LPA observed the hot water temperature to meet requirements at 120.1°F. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C..... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with expiration date of July 24th, 2026 and a CPR certification with the expiration date of September, 2026 Record Review and Resident/Staff Files: LPA reviewed files for Three(3) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Four (4) residents' files were reviewed and contained all required documentation. LPA observed first aid kit, Staff and resident files to be stored in a locked cabinet in the kitchen. Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the kitchen area. LPA reviewed medications for four residents, confirming that all medications were listed and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan and observed to met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to administrator Anahit Mesropyan.the state’s words, verbatim · CDSS document, Dec 3, 2024

Allegation investigated: Staff neglect resulted in resident's change in condition

Licensing Program Analysts (LPAs) Crystal Colvin and Stephanie Martinez conducted an unannounced visit to the facility for the purpose of conducting a complaint investigation for the above allegation. LPAs Colvin and Martinez met with Administrator Anahit Mesropyan and advised her of the purpose of today's inspection. Below is a summary of the investigation. Regarding allegation "Staff neglect resulted in resident's change in condition" - LPAs Colvin and Martinez conducted interviews with residents, staff, and other outside parties with information relevant to the complaint. LPAs additionally reviewed records in Resident 1's (R1) file. According to interviews conducted, there has been no noticable change in R1's medical condition, and R1 remains at their baseline, though has recently been refusing medications. LPA Colvin confirmed that the facility staff have been communicating the refusals to R1's Hospice Agency that oversees his care and there are no concerns with R1's Hospice care team. Therefore, due to lack of evidence to support the allegation, the findings of the allegation "Staff neglect resulted in resident's change in condition" are UNSUBSTANTIATED. Unsubstantiated A finding of UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted with Administrator Anahit Mesropyan and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 30, 2024 · control 18-AS-20240126161108

Allegation investigated: Licensee not advising responsible party when resident was taken to hospital

Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced subsequent complaint visit to the facility. LPA met with Administrator Anahit Mesropyan and informed them of the purpose of this visit. During this investigation LPA conducted interviews with staff, reviewed records, and obtained supportive documentation for review to assist with determining the findings for the above noted allegation. The following was determined. Allegation #1 – Licensee not advising responsible party when resident was taken to hospital. It was alleged that when Resident One (R1) was transported to the hospital to care for a medical condition, staff did not notify R1’s responsible party. Record review indicated that R1 has two responsible parties. After a review of evidence that was Substantiated found undetermined if the records were in fact, refused to be provided for review. Therefore, the allegation could not be corroborated, nor refuted. There were no other witnesses or evidence available at this time to examine; therefore, the allegation was Unsubstantiated. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where a copy of this report was provided along with a copy of the LIC811. obtained through staff, and other interviews, LPA determined that R1’s representative was not notified of R1’s visit to the hospital. Thus, the regulatory requirement to keep R1’s representative regularly informed was not met. The allegation was therefore, Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where a copy of this report was provided along with a copy of the LIC9099D, LIC811, and Appeal Rights.the state’s words, verbatim · CDSS document, Jan 5, 2024 · control 18-AS-20231003142743

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(8) · Plan of correction due date: Jan 12, 2024

Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement was not met as evidenced by: Based on interviews, and record review, Licensee did not notify R1's representative when R1 was sent to the hospital. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 5, 2024

Plan of correction: Licensee agrees to conduct in-service training on the cited regulation. Training due by 5pm on POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted a required annual visit. LPA was greeted and was granted entry and met with Facility respresentative, Michael Anisimov, who was informed of the purpose of the visit. At time of visit there were (5) residents and one (32) staff present. The facility is a one story home with (5) bedrooms and (2) bathrooms with attached garage. The facility does not have a pool or fire arms. The facility is residential care facility for the elderly serving residents ages 60 and above. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following: Infection Control: LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. Physical Plant: Physical plant was observed. The facility's indoor and outdoor area was observed to be free of hazards. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The smoke and carbon monoxide detectors were operational. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Record Review and Resident/Staff Files: S1's staff file was unable to be reviewed for staff training, the deficiency was cited and plan of correction with the staff. The criminal record clearance was able to be verified for S1 and staff present. Health Related Services/ Incidental Medical Services: All client medication was locked in a cabinet. LPA reviewed resident medications R1 and found that no medication list was on file for R1. All other residents had a centrally stored list on file. Deficiency was cited and plan of correction was created with staff. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA observed all facility exits were clear from obstructions. An exit interview was conducted where a copy of this report along with LIC809-D page, and appeal rights were provided to Facility Representative Michael Anisimov.the state’s words, verbatim · CDSS document, Dec 27, 2023

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff spoke inapropriatly to resident Staff was rough with resident causing injury

Licensing Program Analyst (LPA) made an unannounced initial complaint visit to the above noted facility. LPA met with the Licensee/Administrator Anahit Mesropyan and informed them of the purpose of this visit. During this investigation, LPA conducted a tour of the physical plant, conducted interviews with staff, and received supportive documentation for review. The following was determined. Allegation #1 – Staff spoke inappropriately to resident. It was alleged that a caregiver told Resident One (R1) that if R1 went into the refrigerator, the caregiver would break R1’s arm. LPA conducted a staff interview, reviewed facility records, and made observations. Continued on LIC9099C Unfounded Allegation #2 – Staff was rough with resident causing injury. It was alleged that R1 sustained a skin tear as a result of a caregiver grabbing them. Record Review provided by the Licensee indicated that Resident One (R1) did not reside at this location. Based on record review, and observation, this complaint was determined to be Unfounded. An Unfounded finding means that the allegations were false, could not have happened and/or is without a reasonable basis. An exit interview was conducted where a copy of this report was provided. This is an amended version of the original report dated 12/4/2023.the state’s words, verbatim · CDSS document, Dec 12, 2023 · control 18-AS-20231130145348

Allegation investigated: Staff did not administer resident medications as prescribed

Licensing Program Analyst (LPA) Jesse Gardner made an unannounced visit to deliver findings of an investigation into the above allegation. LPA met with Caregiver Murman Umpriani who was informed of the purpose of the visit, and granted entry. LPA then conducted a tour of the facility. The investigation included interviews with staff, residents witnesses, and a review of facility documentation. It was alleged that staff do not administer medications as required. As alleged, R1’s medications were at the pharmacy and not picked up by the Licensee. LPA conducted a review of medication records at the facility, as well as conducted interviews with staff and residents. Through record review, LPA found that R1 moved into the facility on 4/30/23, with all of their medications, and the facility began administering them. Substantiated Interview with Licensee indicated that the Licensee picked up medications for R1 when they were due to be picked up. A receipt was provided to the Department by the Licensee that showed the Licensee picked up medications on 5/24/23 with medication order numbers. Upon examination, this receipt did not include any resident names. Evidence that was provided by a relevant party was examined, and revealed that the Licensee’s list of medications that they picked up, did not include any of R1’s. Thus proving R1’s medications were not, in fact, picked up to be dispensed by the facility. Review of the document indicated that Medication #1 (M1), and Medication #2 (M2) were dispensed on 5/2/23 and had a 30-day supply. M1, and M2 were not again filled until 6/22/23. Thus, this allegation was Substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where a copy of this report was discussed with and provided along with copies of the LIC811, LIC9099D, and Appeal Rights were provided to Licensee/Administrator, Anahit Mesropyan. The Department found that through interviews conducted with relevant sources, R1 did not have many things upon arrival, and during their stay, R1’s clothes were purchased by different relevant parties. Due to conflicting information provided by relevant sources, and staff, and no other witness information available, this allegation was Unsubstantiated. It was alleged that R1 was not able to have visitors during “nap” or “quiet” time. LPA interviewed R1, staff, other residents, and relevant sources, and found that visitors had not been seen turned away by staff to see their residents. This allegation was Unsubstantiated as a result. It was alleged that R1 was not allowed to leave with R1’s responsible party. LPA conducted interviews with staff and residents and found that R1 was allowed to leave with their responsible party, and LPA reviewed documentation provided by the facility that corroborated this. Resident interviews stated that they were also allowed to leave with their responsible parties and had no concern that staff were preventing them from leaving, thus this allegation was Unsubstantiated. It was alleged that staff sleep in the facility and do not supervise residents in care. LPA conducted several interviews with residents and staff and found that staff have not been seen to sleep during the day while caring for residents. Due to interviews conducted, as well as a lack of other evidence available, this allegation was Unsubstantiated. It was alleged that R1 wore the same clothing for several days and looked dingy. LPA conducted interviews with staff, and residents, and found that some residents will wear the same clothing for a couple of days, and one resident interview revealed that it was due to their comfort. Other residents maintained that staff care for their hygiene, and that if residents need a change of clothing, staff assist them with that. Documentation provided by the facility revealed that showers were provided to R1 every 4 days. Interview with R1 revealed that R1 did not feel dirty, nor was in bad hygiene. R1 maintained that staff cared for them. All of the evidence reviewed concluded that this allegation was Unsubstantiated. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where a copy of this report was provided to Licensee/Administrator, Anahit Mesropyan along with copies of the LIC811 (confidential names list).the state’s words, verbatim · CDSS document, Oct 27, 2023 · control 18-AS-20230912151004

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Nov 3, 2023

Additional Personal Rights of Residents in Privately Operated Facilities: (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This did not meet the requirement by: Based on LPA evidence review, the Licensee did not provide medications as ordered by the physician. This is a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 27, 2023

Plan of correction: Licensee agrees to conduct in-service training on the cited regulation, and provide proof of such to LPA by POC date.

Type of visit: Case Management - Deficiencies

On this date, Licensing Program Analyst (LPA) Jesse Gardner made an unannounced visit to the facility to investigate a complaint #18-AS-20231003142743. During today's inspection, LPA Gardner observed the following deficiency, which was reviewed with Administrator Anahit Mesropyan: Reporting Requirements - Through interview with staff, and record review, LPA discovered that Resident 1 (R1) had went to the hospital via ambulance to treat a possible medical episode that they were experiencing. Deficiency was cited for not reporting the incident to the Department within the specified time frame as noted in Title 22. An exit interview was conducted where a copy of this report was discussed with along with copies of the LIC811, LIC809D, and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Oct 5, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Oct 13, 2023

Reporting Requirements: (a)Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not being met as evidenced by: Based on interview withe staff, and record review, LPA determined that there was not a report submitted to the Department in reference to R1 going to the hospital to treat their medical condition. This poses a potential health and safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 5, 2023

Plan of correction: Licensee agrees to review the regulation, and submit in-service training with all staff on the cited regulation. Additionally, Licensee to submit Unusual Incident Report to the Department by POC date.