My Elderly Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 09:45 AM. LPA met with facility staff who contacted the facility Administrator Diana Tavmasyan. The Administrator arrived to the facility at 09:55 AM. Entrance interview was conducted and the reason for the visit was explained. Beginning at 09:56 AM the LPA, along with the facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed the kitchen to contain secured drawers which contained knives and other sharp objects. Additionally, LPA observed secured cabinets and a secured minifridge which contained resident medications. COMMON AREAS: This includes the entryway, hallway, and Administrator’s office. LPA observed the entryway to contain adequate seating, a dining table, a television, and activities for resident use. LPA observed the hallway to contain secured storage which contained staff personal items, a washer and dryer, cleaning supplies, laundry supplies, extra linens, and additional activities. LPA observed the hallway to contain a wall mounted fire extinguisher to be fully charged and last serviced on 01/10/2025 which is outside of the range required by regulation. LPA informed the Administrator who agreed to have the extinguisher serviced. LPA observed the Administrator’s office to contain resident, staff, and facility files. The Administrator’s office was observed to be secured from residents in care. CONTINUED ON LIC 809C. BEDROOMS: There are four (4) bedrooms in the facility; two (2) are dual occupancy resident rooms, two (2) are single occupancy resident rooms. LPA and the Administrator toured all four (4) bedrooms. All four (4) resident rooms observed were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. All bedrooms contained direct exits to the outdoors of the facility. BATHROOMS: There are two (2) common resident bathrooms at the facility. Both resident bathrooms observed were clean and were equipped with nonskid surfaces. Grab bars were observed in all showers and near all toilets, all were properly secured. The water temperature was measured to be between 111.6 and 117.1 degrees Fahrenheit, which is in compliance with regulation. OUTDOOR SPACE: The facility had adequate shaded seating outdoors for resident use. LPA observed all emergency exits to be clear from obstructions. LPA observed two (2) emergency exit gates at the facility. LPA observed cameras located throughout the outdoors of the facility. RECORD REVIEW: Record review began at 10:52 AM. Staff and Resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Five (5) resident files were reviewed. All resident files contained all required documentation and signatures. Five (5) staff files were reviewed. One (1) staff file was observed to be missing proof of a negative TB test, and one (1) staff file was observed to be missing confirmation of good physical health completed by a physician. LPA informed the Administrator that good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician. The Administrator expressed understanding and agreed to obtain a TB test and a completed health screening for the identified employees. MEDICATION REVIEW: Medication review began at 12:28 PM. Medications for three (3) of five (5) residents were observed. LPA observed two (2) medications to not be appropriately documented on their respective Centrally Stored Medication and Destruction Sheets (CSMDRs). LPA informed the Administrator who logged the medications at the time of the visit. All medications were observed to be stored properly. CONTINUED ON LIC 809C. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are to be conducted quarterly; the facility was unable to provide LPA with a log of the last complete disaster drill. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that the staff treat them well and are attentive to their needs. LPA interviewed two (2) staff members. Both staff members interviewed were knowledgeable on the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, updated disaster plan, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Apr 14, 2026

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Trevor Byrne conducted a pre-licensing visit to the above noted facility. The LPA met with applicant, Dianna Tavmasyan. This is a new facility application. A dementia care program was included in the plan of operation. A Hospice Waiver has been requested. The facility is a one-story home. Beginning at 09:51 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for six (6) bedridden residents. The facility has two (2) private resident bedrooms and two (2) shared resident bedrooms. All resident rooms have direct exits to the outside. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs, and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are no staff rooms awake night staff only is required. All rooms were free of odors. All window screens were clean and maintained in good repair. There are two (2) bathrooms in the hallway. All resident bathrooms have a shower with non-skid materials. All toilets and showers have grab bars. The hot water temperature was tested in all bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. Resident and staff records are stored in a locked desk drawer which is currently located in the Administrator’s office. Medications are centrally stored in a locked cabinet in the kitchen. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in a locked hallway cabinet. Continued on LIC 809C. Kitchen knives are stored in a locked drawer in the kitchen. Stove burners are rendered inaccessible to the residents via the use of child proofing knobs. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet located in the facility hallway. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment, games and activity supplies in the living room/dining area. LPA observed cameras located throughout the common areas of the facility. LPA confirmed with applicant that audio is not recorded. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight were made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. There was no fireplace observed at the facility. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility’s combination smoke and carbon monoxide alarm system is hard wired. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. There is one (1) fire extinguisher throughout the house. It is fully charged and does not exceed the expiration date. Continued on LIC 809C. Hot water was tested in each bathroom, which included all common bathrooms, in addition to the kitchen; and, the hot water ranged from 110.7 to 116.8 degrees Fahrenheit. The laundry area is located in a closet in the hallway of the facility. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in each resident room. Extra incontinence supplies are stored in a storage shed located in the backyard of the facility. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted throughout the common areas of the facility and in each resident room. The emergency telephone numbers along with other required postings are posted on the wall in the living room. The exterior passageways were clean and clear of any obstructions. There is a covered patio area on the side of the house with tables and chairs where residents can sit. The entire property is fenced. The gate to the driveway is moved manually. There is a door gate for persons to enter the front yard. There are two (2) locked storage sheds located in the back yard. There are not any bodies of water on the premises at the present time. Component III (COMP III) orientation was completed with the applicant at the time of this inspection. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.the state’s words, verbatim · CDSS document, Mar 12, 2025

Type of visit: Office

Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): COMP II Participants: Diana Tavmasyan, Admin and Applicant Interview Method: Telephone interview On 2/18/25, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst Starla Currin confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 18, 2025