Neasis

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Huma Rahimi conducted unannounced visit to this facility in conjunction with a complaint control # 31-AS-20260304131625. LPA met with Staff #2 (S2) who granted access to facility. The Administrator was contacted LPA explained the reason for the visit. The Administrator at around 10:00 AM. During the visit, the LPA was informed that Resident #1 (R1) experienced a panic attack on 02/26/2026, and 9-1-1 was called. R1 was transported to the hospital for further evaluation. Additionally, on 02/12/2026, Resident #3 (R3) experienced confusion, and 9-1-1 was called. R3 was also transported to the hospital. However, the facility failed to submit Unusual Incident/Injury Reports to the Community Care Licensing Department (CCLD) within the required time frame. The LPA reviewed the incident reporting system and did not observe any incident reports submitted for the above events involving R1 and R3. The Administrator acknowledged that incident reports were not submitted to the Regional Office (RO) for these occurrences. According to Title 22 Regulations, a written Unusual Incident/Injury Report must be submitted to CCLD within seven (7) days of the occurrence. The LPA informed the Administrator that all staff members are mandated reporters and are responsible for ensuring reportable incidents are submitted to the Department in a timely manner. The LPA instructed the Administrator to submit incident reports to the Regional Office for the following incidents: 02/12/2026 – Resident #3 (R3) transported to the hospital after experiencing confusion 02/26/2026 – Resident #1 (R1) transported to the hospital after experiencing a panic attack Appeal rights explained and exit interview conducted. Copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Mar 9, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)A,B&D · Plan of correction due date: Mar 16, 2026

Requirements (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person... ... any of the events specified in (A), (B) & (D)... This requirement is not met as evidenced by: Based on interviews and record reviews, conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding R1's hospitalization on 02/26/26 and R3's on 02/12/26, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 9, 2026

Plan of correction: Licensee shall ensure a written report is submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of any of the events. R1's & R3's incident reports shall be submitted to LPA by POC date.

Allegation investigated: Staff do not afford residents privacy as cameras are placed in restricted areas

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. LPA met with the administrator, Gevorg Khaluyan, and advised him of the complaint. It was reported that all residents have cameras in their bedrooms, and unknown if these residents or their authorized representatives gave consent to place cameras in their bedrooms. Today's investigation consisted of interviews with the administrator, staff and residents. LPA also conducted a physical plant inspection and record review. Prior to the investigation, LPA Cava conducted a review of FAS notes. During pre-licensing visit on 06/01/23, it was documeted that the facility has surveillance cameras located inside and outside of the facility. Interviews with the administrator confirm that there are cameras in common areas, that are video only and no audio. Administrator also confirmed that there is a video camera only, no audio, in room #4. Room #4 Unsubstantiated is a private room. Administrator stated Resident 1 (R1), who occupies room #4, has authorization from from R1's family, allowing the use of video in the room for safety monitoring reasons, as R1 is blind. Video camera is for visual only. No audio. In conjunction with this complaint, a required annual was made. LPA inspected all four (4) rooms, occupied by the residents, and confirmed that there was that one camera in room #4. LPA obtained documentation from R1's files, authorizing the use of the camera, signed by R1's responsible person. In addition to the camera in room #4, there were surveillance cameras located inside and outside of the facility. No audio in place. LPA checked the placement of these cameras to insure lenses are directed in common areas only, and do not violate the residents rights. In addition to the physical plant inspection and record review, interviews with the other three (3) residents confirm no cameras in place in their rooms. Interviews made with two (2) of two staff also deny cameras installed in restricted areas. Staff confirm only camera installed in resident room has the resident's responsible person's consent. Based on the information obtained, although there is a camera installed in a R1's room (room #4), the licensee maintains written authorization from R1's family allowing for the camera to be installed and in use there for safety reasons. Moreover, R1's room is private, and no other residents share the room with R1. Therefore, the allegation of staff not affording residents privacy as cameras are placed in restricted areas is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Aug 6, 2025 · control 31-AS-20250729152612

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Gevorg Khaluyan, and explained the reason for the visit. At approximately 11:00am, with the assistance of the administrator, LPA took a tour of the physical plant. Required postings were observed in common areas and throughout the facility. The smoke alarms and carbon monoxide are dual and interconnected. There is one brand new fire extinguisher, located in the kitchen. It was purchased on 07/08/25 Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Cleaning supplies were stored locked in the laundry area, located adjacent to the kitchen. Bedrooms: There are five (5) bedrooms, of which four (4) are designated for residents' use. Rooms #1 & #3 are shared. Rooms #4 and #5 are private. Room #2 is designated to staff. The four bedrooms, in use by the residents were observed to be properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms. One for staff, and one for residents. The bathroom designated for resident use is properly supplied and had functional fixtures. Hot water temperature was measured at 109 degrees Fahrenheit. Common Areas: The living room is furnished with two couches, table and television. There is a fireplace that is properly screened. No fireplace tools were present. The dining room table is large enough to seat up to six (6) individuals. Living room and dining room furniture were observed to be in good repair. Floors were mopped and clean. Entry/exits, hallways and passageways were clear. Surrounding Grounds: The backyard was free of hazards. There was furniture in the backyard, appropriate for outdoor use. The side gate has no exterior lock and is clear to exit/evacuate in case of an emergency. There is a storage locker that was observed lock. There are no bodies of water. Laundry area: The laundry area is located adjacent to the kitchen. Detergents and cleaning supplies are maintained there. Laundry area was locked during the visit. Staff Workstation/Office: There is a staff workstation located across from the living room where medication, staff and resident records are kept locked Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records were reviewed for proper storage and documentation. Garage: There is no garage. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Aug 6, 2025

Type of visit: Case Management - Annual Continuation

At 2:00pm on 08/01/2024, Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced continuation of the annual inspection, 07/30/2024. LPA was greeted by Maria Duran, caregiver and explained reason for the visit. Due to a technical error with the system during the annual inspection held on 07/30/24 and the LIC809D was not discoverable which resulted to LPA not being able to get a signature on the LIC809D. Today, LIC809D was recovered and LPA was able to obtain administrator's Gevorg Khaluyan's signature on the LIC809D. During the visit today the facility was in compliance with Title 22 regulations. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Aug 1, 2024

Type of visit: Required - 1 Year

Another LIC809 has been generated to reflect signatures that did not register or reflect on this report. Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced required 1-yr inspection. LPA was allowed entry by Maria Durand, caregiver at 11:30am and explained the purpose of the visit. At 12:00pm, Gevorg Khaluyan, Administrator/Licensee arrived, LPA explained the purpose of the visit. LPA reviewed resident files, staff files and conducted a tour of the facility between 12:00pm to 3:00pm. Outside: LPA toured the outside area. LPA observed a shaded sitting area for residents. There is a ramp access with sturdy hand railings. The facility does not have any bodies of water. Common Area: LPA observed all furniture to be clean and in good repair. The facility maintains a comfortable temperature at 73 degrees Fahrenheit. The air conditioner is operational. The facility smoke alarm system is hard wired and interconnected. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. Sprinkler systems are hardwired and interconnected. At 1:00pm they were tested and deemed operational. Facility maintains a telephone land line and it was observed to be operational. Required postings were observed. The fire extinguishers is located in the kitchen with purchase date of 04/26/2024. Food Service and Kitchen Area: The kitchen appliances were functional. The kitchen has a working stove, faucet, refrigerator and microwave. LPA found enough food for at least three (3) days perishable and seven (7) days non-perishable which are properly stored. Knives were stored in a magnetic lock drawer. Food preparation areas are clean. Garbage can have a tight fitting cover. The laundry room which is inaccessible and locked is located near the kitchen area. There is a functioning washer and dryer. Laundry detergents and cleaning solutions were stored in the locked laundry room. Residents' dining table accommodates six (6) people. Continued to LIC809-C Bedrooms: LPA observed all four (04) bedrooms to be properly furnished with appropriate dresser, night stand, chair, beddings and linens with sufficient lighting. Extra linens and beddings are stored in the hallway closet. Bedroom #1 is occupied currently by one (1) resident. Bedroom #2 is for staff use only, which remained locked. Bedroom #3 is occupied and shared by two (2) residents. Bedroom #4 is not currently occupied. Bedroom #5 is occupied by one (1) resident. Bathrooms: LPA observed two (02) bathrooms at the facility, one (01) is for residents to use and one (01) is for staff use only which is kept locked. Resident bathrooms have hand washing signs, soap and paper towels. Proper grab bars and non-slip bath mats. The water temperature in the resident bathroom is 112.7 degrees Fahrenheit. Personnel Records/Staffing: LPA Reviewed files for four (4) staff members. Files are maintained at the facility in a locked 4 drawer cabinet. Proof of staff training, health clearance, vaccinations and 1st Aid/CPR training are current for two (2) staff members. Staff employed all have criminal background clearance, fingerprint cleared and associated to the facility. LPA observed two (2) caregivers S1 and S2, 1st Aid/CPR certification were expired. Residents Records: LPA reviewed files for four (04) out of four (04) residents. Files are maintained at the facility in a locked 4 drawer cabinet. Physician's Report (including TB and Ambulatory Status), Consent For Medical Treatment, and Admission agreements, Medical/Functional assessments, Needs and Services Plans, Personal rights. Medications were reviewed for one (01) resident to confirm medication is given as prescribed and is documented properly. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are administered as prescribed by the Physician. Medications are bubbled packed. Medications are in a locked cabinet The First Aid Kit is complete and current. Deficiency issued. An exit interview was conducted, and a copy of this report was provided to licensee/administrator. .the state’s words, verbatim · CDSS document, Jul 30, 2024

Type of visit: Required - 1 Year

This LIC809 has been generated to reflect signatures that did not register or associated on the previous report. Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced required 1-yr inspection. LPA was allowed entry by Maria Durand, caregiver at 11:30am and explained the purpose of the visit. At 12:00pm, Gevorg Khaluyan, Administrator/Licensee arrived, LPA explained the purpose of the visit. LPA reviewed resident files, staff files and conducted a tour of the facility between 12:00pm to 3:00pm. Outside: LPA toured the outside area. LPA observed a shaded sitting area for residents. There is a ramp access with sturdy hand railings. The facility does not have any bodies of water. Common Area: LPA observed all furniture to be clean and in good repair. The facility maintains a comfortable temperature at 73 degrees Fahrenheit. The air conditioner is operational. The facility smoke alarm system is hard wired and interconnected. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. Sprinkler systems are hardwired and interconnected. At 1:30pm they were tested and deemed operational. Facility maintains a telephone land line and it was observed to be operational. Required postings were observed. The fire extinguishers is located in the kitchen with purchase date of 04/26/2024. Food Service and Kitchen Area: The kitchen appliances were functional. The kitchen has a working stove, faucet, refrigerator and microwave. LPA found enough food for at least three (3) days perishable and seven (7) days non-perishable which are properly stored. Knives were stored in a magnetic lock drawer. Food preparation areas are clean. Garbage can have a tight fitting cover. The laundry room which is inaccessible and locked is located near the kitchen area. There is a functioning washer and dryer. Laundry detergents and cleaning solutions were stored in the locked laundry room. Residents' dining table accommodates six (6) people. Continued to LIC809-Cthe state’s words, verbatim · CDSS document, Jul 30, 2024

Allegation investigated: Staff left resident on the floor

Licensing Program Analyst (LPA) Christopher Alemoh conducted a subsequent complaint visit to the facility to investigate the above allegation. LPA met with the Administrator Levon Khalulyan and advised them of the complaint. It was alleged that staff left resident on the floor. To investigate the allegation, on 1/31/2024, at 1030 LPA conducted a physical plant tour. At 11:15 AM LPA requested facility files at 12:00 PM, LPA interviewed (6) staff at 1:30 PM and three (3) residents at 2:30 PM. Physical plant tour revealed all residents have call buttons. File review noted all staff is up- to date on Staff trainings. Administrator stated all residents are checked on every twenty to thirty minutes. taff Three (3) out of (4) four resident interviews stated they have never fallen at the facility. Unsubstantiated Staff provides a good and safe level of care. R1 stated prior to this incident she has never fallen, and staff has never left her unattended. R1 stated both staff and her fell and staff rendered aid. Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No health and safety hazards noted during the visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 31, 2024 · control 31-AS-20231025083533