No Place Like Home for Golden Ages

Type of visit: Required - 1 Year

A Required One (1) year - Annual visit was conducted today by Licensing Program Analyst (LPA) Rosaura Valenzuela. LPA met with staff Gayane Khachatryan and explained the purpose of the visit. LPA observed that six (6) residents were at the facility during visit. A tour of the physical plant was conducted at 12:30 PM and the following was noted: The front main door is the only entrance being utilized at the facility. The facility is a single story home with four (6) private client bedrooms and three (3) bathrooms. There is no body water in the facility. Bedrooms were toured and observed to be clean and properly furnished. Linen storage was also checked and observed to have ample supply of clean linen and towels. Bathrooms were observed to be clean and sanitary with necessary supplies. Hot water temperature measured at a range of 105.6°F to 114.3°F and within the required range. Physical plant was checked for cleanliness and condition. Facility was in good repair and observed to be clean and free of clutter during today's visit. Living, dining & family room furniture were also checked for functionality (wear and tear). Furniture was observed to be in good condition. Kitchen area was observed to be clean and sanitary. All the toxins, cleaning solutions and disinfectants are locked in the cabinet below the kitchen sink. Knives and sharps are kept in the a locked storage located near the dining area. Food. The facility is observed to have sufficient food supply for the clients both perishable and non-perishable. Temperature of facility wall thermostat is set at 74.0°F and observed to be within the required range. Fire extinguishers. The facility has three (3) fire extinguishers which were last bought on 01/25/22. Carbon monoxide and smoke alarms are hardwired and interconnected, tested and observed to be operable. Garage is attached to the house and access has to go through the Laundry room. Garage was observed to be locked and inaccessible to residents. The garage is also used as a storage for PPE and other supplies. Client records were reviewed for current IPP’s and/or Needs and Service plans, physician report, admission agreements, etc. Client records appeared to be complete and current. Medication was observed to be inaccessible to residents and stored in a secured cabinet. There is a complete First Aid kit. Staff records were reviewed. Staff present records were observed to be current and updated. Exit interview conducted and a copy of this report was given.the state’s words, verbatim · CDSS document, Aug 17, 2023

Allegation investigated: Resident is not allowed to use the restroom Resident is restrained in the wheelchair Staff do not treat resident with dignity Resident lost a lot of weight Staff do not provide alternative meals Staff are not following physicians orders Resident is made to go to bed at 3:00 PM

Licensing Program Analyst (LPA) Angelica Rea conducted a subsequent visit in response to the above allegations. On today's visit, LPA met with Staff, Alla Abgean, who assisted with the visit. LPA spoke to Administrator, Emma Topadzhikyan via telephone regarding the allegations. Resident #1 is no longer residing at the facility, and was not able to be interviewed. Regarding the allegation that Resident #1 is not allowed to use the restroom, the investigation consisted of interviews with Administrator, Staff #1, Staff #2, and resident #2 - resident #5. Administrator and staff interviewed denied the allegation. They stated that they assist residents with all of their needs, including going to the restroom. Residents interviewed were unable to corroborate the allegation. Four out of four residents denied that they are not allowed to use the restroom. Regarding the allegation that resident #1 is retrained in the wheelchair, the investigation consisted of interviews with Administrator, Staff #1, Staff #2, and resident #2 - resident #5. Unsubstantiated Administrator and Staff interviewed denied the allegation. They stated that residents are not restrained in their wheelchair(s). Residents interviewed were unable to corroborate the allegation. Residents who use a wheelchair, stated that they have not been restrained. Four out of four residents stated that they have not been restrained in any way. Regarding the allegation that Staff do not treat resident #1 with dignity, the investigation consisted of interviews with Administrator, Staff #1, Staff #2, and resident #2 - resident #5. Administrator and staff interviewed denied the allegation. They stated that they treat all of their residents with dignity. Residents interviewed were unable to corroborate the allegation. Four out of four residents stated that they are treated with respect and dignity by staff. Regarding the allegation that Resident #1 lost a lot of weight, the investigation consisted of interviews with Administrator, Staff #1, Staff #2, and resident #2 - resident #5. Administrator and staff interviewed denied the allegation. They stated that they did not observe that resident #1 lost a lot of weight. Residents interviewed were unable to corroborate the allegation. Four out of four residents stated that they receive plenty of food, and they have not lost a lot of weight. Regarding the allegation that Staff do not provide alternative meals, the investigation consisted of interviews with Administrator, Staff #1, Staff #2, and resident #2 - resident #5. LPA also reviewed facility food supply, and observed a sufficient amount and a variety of food available. Administrator and staff interviewed denied the allegation. They stated that they do offer alternate meals, if a resident doesn't want what is being served. Residents interviewed were unable to corroborate the allegation. Four out of four residents stated that the staff will offer them alternate meals, if they request it. Regarding the allegation that Staff are not following physicians orders, the investigation consisted of interviews with Administrator, Staff #1, Staff #2, and resident #2 - resident #5. Administrator and staff interviewed denied the allegation. They stated that they follow physicians orders for all of the residents. Residents interviewed were unable to corroborate the allegation. Four out of four residents interviewed stated that the staff do follow their physicians orders. Regarding the allegation that Resident #1 is made to go to bed at 3:00 PM, the investigation consisted of interviews with Administrator, Staff #1, Staff #2, and resident #2 - resident #5. Administrator and staff interviewed denied the allegation. They stated that they do not make any of the resident(s) go to bed. They stated that some residents choose to rest in the afternoon, but they do not make them. Residents interviewed were unable to corroborate the allegation. 4 out of 4 residents interviewed, stated they staff do make them go to bed. They stated that they can stay up as late as they choose. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview was conducted, and a copy of this report was provided to Ms. Khachatryan.the state’s words, verbatim · CDSS document, Aug 3, 2023 · control 28-AS-20220614122018

Allegation investigated: Resident developed pressure injuries while in care.

Licensing Program Analyst (LPA) Elizabeth Irra arrived to this facility and met with Emma Topadzhikyan. The purpose of today's visit is to deliver findings for the above allegation. On 11/03/2020, Licensing Program Analyst (LPA) Elizabeth Irra initiated a complaint investigation for the allegation noted above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, the initial complaint investigation was conducted telephonically with Emma Topadzhikyan (Facility Administrator). At approximately 9:15 A.M, LPA Irra spoke to the Facility Administrator via telephone. LPA requested the following: Resident and Staff rosters with contact information. LPA also requested Facility Administrator to submit the following for Resident #1 and Resident #2 (R-1 and R-2): Emergency Contact Information, Pre-Placement Appraisal, Appraisal Needs and Services Plan, Admission Agreement, Power of Attorney (POA) documentation, Physician's Report (annual exam), Dental Consultation records, Medication Administration Records (MAR's) for September 2020 and October 2020, Daily notes for September 2020 and October 2020 and Hospice notes from September 2020 and October 2020. At approximately 1 P.M., LPA conducted a tele-visit tour of the building and grounds and did not observe any signs of neglect, abuse or other immediate health and safety threats. *Refer to LIC 9099C for continuation.* Substantiated The investigation for this allegation was conducted by Investigator Peter Zertuche. During the course of this investigation, Investigator Zertuche, reviewed hospice records in which indicate the victim (R-2) was admitted to this facility on 10/13/2020 “without impairments but after a few days, two pressure injuries began to form. The facility was directed to reposition every two hours, but it was noted on hospice records that the victim (R-2) was in the same position during every nurse visit. Approximately one week after being admitted to the facility, the victim’s (R-2) pressure injuries worsened and on October 28, 2020, the injury was unstageable. Hospice records also noted that the facility did not reposition as necessary and poor care was provided. Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Tittle 22, Division 6 and Chapter 8 are being cited. Immediate Civil Penalties will be issued today, in the amount of $500.00 due to Resident developed pressure injuries while in care. At this time an Enhanced Civil Penalty (ECP) determination is pending in reference to Health and Safety Code 1548(f)(1)(B)(i) and may be assessed at a later date. Exit interview held. A copy of the LIC9099, LIC9099C, LIC9099D and LIC421IM (Civil Penalty Assessment), and Appeal Rights were provided to Emma Topadzhikyan Allegation: Resident's hygiene needs are not being met. During today’s visit, LPA interviewed Resident #3 (R-3), Resident #4 (R-4) and Resident #5 (R-5). LPA was unable to interview Resident #6 (R-6) as R-6 was asleep at the this of this visit. LPA was unable to interview Resident #1 (R-1) and Resident #2 (R-2) as they no longer reside at this facility. LPA also interviewed Staff #1 through Staff #3 (S-1 through S-3). Resident interviews revealed that staff provide assistance with residents’ hygiene needs. Interviewed residents indicated they do not have any concerns and that their hygiene needs (including dental) are being met by staff. Staff interviews revealed that staff assist resident with their hygiene needs including oral hygiene on a daily basis. Interviewed staff indicated that staff do not keep a log to reflect that residents were assisted with oral hygiene. Interviewed staff indicated they have not received any complaints/concerns in regards to residents hygiene needs not being met. During this visit, LPA also observed staff assisting residents with their hygiene needs and also observed residents to have hygiene supplies. Resident and staff interviews do not corroborate this allegation. 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, therefore this allegation is unsubstantiated. Exit interview conducted and appeal rights and a copy of this report was provided to Emma Topadzhikyan.the state’s words, verbatim · CDSS document, Jan 19, 2023 · control 28-AS-20201030121542

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Jan 20, 2023

Personnel Requirements General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and as required in Section 87608, Postural Supports. This standard is not met at evidence by: Please refer to page (4) of the LIC 9099 report for details.the state’s words, verbatim · CDSS document, Jan 19, 2023

Plan of correction: Licensee shall develop a written Plan of Correction to ensure compliance with California Code of Regulations Title 22, Section 87411(a) Written POC must be submitted to CCL by the POC due date. **Immediate Civil Penalties will be assessed in the amount of $500.00.**

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nune Margaryan conducted an annual required visit. LPA met with the staff Willeta Frani who assisted with the visit. Reason for the visit was explained. LPA used the infection control tool to evaluate the facility. LPA inspected the physical plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed residents and staff files. The facility is licensed for six (6) residents over the age of 60, 5 non-ambulatory, one of which can be bedridden. The facility was granted on hospice waiver for 2 residents. There is only one entrance being utilized at the facility, all required posters were posted at the entrance. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask upon entrance and during visit. LPA inspected the interior and the exterior of the facility with staff including but not limited to living room, dining room, activity room, kitchen, six (6) resident bedrooms, three (3) bathrooms, laundry area, attached two car garage and outside covered/patio area with chairs. Front and back yards are well maintained. LPA observed drained gated locked pool in backyard. All indoor and outdoor passageways are free of obstruction. Bathrooms and bedrooms were clean and in good repair. All residents bedrooms were toured. Each bedroom were furnished with required furniture and had sufficient closet space. Three bathrooms were toured. Bathrooms have the required grabs bars and non-skid mats. The hot water was 115.3 - 116.7 degrees which is within the required 105 - 120 degrees. LPA observed fire extinguisher in activity room which was fully charged. Carbon monoxide detectors were observed operational. First-aid Kit is complete and located in the activity room. There is a locked cabinet for medications in the kitchen. Continue 809C The kitchen was toured. All appliances were operating properly. There was a sufficient amount of perishable and non-perishable food. Kitchen knives and sharps are stored in a locked drawer in the kitchen. The common areas including the living room, dining room and activity room are clean and have the required furniture. The facility has cameras in the common areas only. LPA reviewed residents files to confirm emergency contact is updated. LPA also reviewed staff files to confirm health screenings and fingerprint clearances. All staff files reviewed were fingerprint cleared. Residents' medications were reviewed. Medications are documented properly and stored appropriately. Based on California Code of Regulations, Title 22, there were no deficiencies observed during the visit. A copy of the report was provided to the Staff Willeta Frani.the state’s words, verbatim · CDSS document, Apr 14, 2022