Noho Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool. LPA Yee met with Arpine Mkrtchyan, Administrator. Also present during the visit was Arsen Yanukyan and Anahit Anatomyan, Staff. The reason for today's visit was provided. The facility is a single storey family home consisting of a living room, dining room, a kitchen, 3 resident bedrooms, 2.5 bathrooms, a den, a laundry room and a attached garage. The facility is fire cleared for 6 non-ambulatory residents. On today's visit, all 12 domains of the CARE Inspection Tool, 4 resident and 5 staff files were reviewed. 1 resident is receiving hospice services and 2 residents are receiving home health services. A tour of the physical plant was also conducted inside and outside. The following was observed on today's visit: the living room, dining room and kitchen are furnished and equipped with the appropriate furniture and equipment for its designated use. The fire place located in the living room was observed with a fire screen. all three resident rooms are shared rooms and are furnished with 2 beds, 2 night stands, 2 lamps, 2 chairs, 2 dressers and a built in closet. All the windows were observed with blinds for privacy. the facility has 2.5 bathrooms. A full private bathroom was observed in bedroom #1. The bathroom has a walk in shower, a toilet and a vanity with a single sink. Grab bars, a slip resistant mat and a shower chair were observed. The water temperature was tested and read 115.9 degrees Fahrenheit. Continued on LIC809-C Page 2 the common bathroom located in the resident hallway is equipped with a tub with a shower head, a toilet and a vanity with a single sink. Grab bars and a slip resistant mat was observed. The water temperature was tested and read 116.1 degrees Fahrenheit. the other common bathroom also located in the resident hallway is equipped with a toilet and a vanity with a single sink. The water temperature was tested and read 115.8 degrees Fahrenheit. extra bed linens and towels were observed in the linen closet located in the hallway. the laundry closet was observed with a washer and dryer. Laundry detergents are locked in a locked cupboard. the hardwired smoke detectors located in the resident bedrooms and the combination smoke/carbon monoxide detectors located in resident hallway and in the living room were tested and were operational. The fire rated door located between the living room and resident hallway was activated when the smoke detectors were triggered and released the door to secure the bedrooms. the only fire extinguisher is located in the kitchen was purchased on 7/14/26. sufficient perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed maintained on the premises. the Administrator's certificate is current. the first aid kit was reviewed and a first aid manual was observed. the facility has current liability insurance that meets Title 22 requirements. medications are stored in a metal filing cabinet located in the kitchen. disinfectants and cleaning solutions are stored in a locked cabinet under the kitchen sink, sharp knives are stored in a locked kitchen draw and the laundry detergent are stored in a locked cupboard in the laundry closet. a table with chairs and an umbrella were observed in the backyard. trash cans stored in the front yard were observed to be tightly sealed. overall the inside and outside of the facility were observed to be clean. No deficiencies cited on today's visit. Exit interview was conducted.the state’s words, verbatim · CDSS document, Aug 26, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 10:00 a.m., the LPA met with staff and explained the reason for it visit. At 10:20 a.m., Administrator Arpine Mkrtchyan arrived at the facility. RECORD REVIEW: Between 10:15 a.m. and 11:26 a.m., the LPA conducted a file review for all four (4) residents and staff regularly scheduled and observed the following: Staff have current first aid and training documentation. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All files were in order. The Administrator’s Certificate is valid until 10/13/2025. The last fire drill took place on 07/01/2025. The LPA observed documentation of the Infection Control Plan and Emergency and Disaster Plan. At 10:54 a.m., the LPA conducted a review of medication and medication documentation with the Administrator for two (2) out of four (4) residents and observed that medications were properly documented and assisted as prescribed. Medications are locked and centrally stored in a filing cabinet inside the kitchen. At 12:40 p.m., the LPA, along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. KITCHEN: The LPA observed the kitchen and dining area. Knives are stored in a locked drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 12:49 p.m., hot water measured at 115.5-degree Fahrenheit. Continued on LIC-809-C. BEDROOMS: The facility is a single-story residential home with three (3) bedrooms and three (3) bathrooms. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Starting at 12:52 p.m., hot water temperature measured between 106.5 and 111.6-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. OUTDOOR SPACE: At 1:00 p.m., the LPA observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. There are no bodies of water on the premises. Additional food supplies and water are stored in the garage. Laundry units are located inside the locked laundry room. Cleaning solutions are located inside the laundry room. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and purchased on 11/12/2024. At 1:04 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. All exits have functioning auditory devices and were operational at the time of the visit. There is a working telephone on premises. The LPA observed additional clean linens and towels in the hallway closet. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Aug 27, 2025

Allegation investigated: Facility staff did not seek timely medical attention for resident

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and was let into the home by Anahit Anatomyan, Staff. Arpine Mkrtchyan, Administrator was contacted by staff to advise her that Licensing was at the facility and she arrived at 11:44 am to conduct the visit. The reason for today's visit was explained. On today's visit, LPA Yee conducted an interview with the Administrator at 11:47am and staff #1 at 1:38pm and reviewed and obtained available facility files at 12:33pm. Additional files will be emailed to LPA Yee later today. Per information received from interviews conducted, on 11/12/24, Resident #1 was given breakfast around 9am and lunch around 12:30pm and resident ate very little food and was not hungry. Resident #1 is known Substantiated for their hearty appetite. After lunch, Resident #1 was changed by caregiver and they were observed breathing heavily despite being on oxygen and the Administrator was advised. The Administrator notified the family that the resident did not have an appetite and also contacted Resident #1's doctor around 1 or 1:15pm to notify the doctor about Resident #1's heavy breathing. Per the doctor's instructions, the Administrator was told to increase Resident's oxygen level from 2 liters per minute to 4 liters per minute. Resident continued to have difficulty breathing even after increasing the oxygen level. Emergency services was not contacted until later in the afternoon when the resident's ability to breath became rapidly more difficult. The Administrator was guided by 911 personnel to perform cardiopulmonary resuscitation until the paramedics arrived at the facility to take over. Per the Administrator, this is the first time that she encountered a situation like this and she thought she was doing the right thing by contacting the resident's doctor for instructions and notifying the family, instead of calling 911 immediately. Based on the information received from the interviews conducted, there is sufficient evidence to support the allegation that facility staff did not seek timely medical attention for resident. Therefore, the allegation is substantiated at this time. Deficiency cited under California Code of Regulations, Title 22, Division 6, Chapter 8 Exit interview was conducted, Appeals Rights discussed and a copy was provided.the state’s words, verbatim · CDSS document, Nov 18, 2024 · control 29-AS-20241113140220

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Nov 19, 2024

Incidental Medical and Dental Care: The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met as evidenced by: Resident #1 was observed having difficulty breathing before lunch and the staff did not call 911 services until the late afternoon when the resident's ability to breathe rapidly declined.the state’s words, verbatim · CDSS document, Nov 18, 2024

Plan of correction: Licensee will review their emergency protocol and draft a written plan of action that will be implemented to ensure that all residents are provided with immediate emergency services by 11/19/24 Licensee will also provide staff with personal rights training and submit evidence of training by 11/25/24.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced case management visit due to the deficiencies noted during a visit to the facility today. The following was observed during today's visit: Hospice services were initiated for Resident #1 on 11/8/24 and it was not reported to the Department within 5 days as required Oxygen is in use by Resident #1 and the Licensee did not report it in writing to the fire department. The incident and hospitalization of Resident #1 was also not reported to the Department but they have till the end of today to file the incident report. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8 Exit interview was conducted, Appeals Rights discussed and a copy was given.the state’s words, verbatim · CDSS document, Nov 18, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87618(b)(3)(A) · Plan of correction due date: Nov 25, 2024

Oxygen Administration - Gas and Liquid: In addition to Section 87611(b), the licensee shall be responsible for the following: Ensuring that the use of oxygen equipment meets the following requirements: A report shall be made in writing to the local fire jurisdiction that oxygen is in use at the facility. This requirement was not as evidenced by: Resident #1 uses oxygen and it was not reported to the local fire department as of today's visitthe state’s words, verbatim · CDSS document, Nov 18, 2024

Plan of correction: Licensee will submit written notification to the local fire department of oxygen being used at the facility. A copy of the notification letter will be provided to the Department as evidence that the local fire department was notified by 11/25/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87632(d)(2) · Plan of correction due date: Nov 25, 2024

Hospice Care Waiver: If the Department grants a hospice care waiver it shall stipulate terms and conditions of the waiver as necessary to ensure the well-being of terminally ill residents and of all other facility residents, which shall include, but not be limited to, the following requirements: The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services. The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice. Resident #1 was receiving hospice services begining 11/8/24 and it was not reported to the Departmentthe state’s words, verbatim · CDSS document, Nov 18, 2024

Plan of correction: Licensee will submit an hospice initiation letter to the Department for all residents who are placed on hospice within 5 days of initiation. Licensee will submit a hospice initiation letter with the name of the resident, date of initiation, name of the hospice agency and address and telephone number by 11/25/24

Type of visit: Required - 1 Year

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool. LPA Yee was let into the facility by Anahit Anatomyan, Staff. Arpine Mkrtchyan, Administrator, was contacted via telephone and she arrived at 11:25am to conduct the visit. The reason for the visit was provided. The facility is a single storey family home consisting of a living room, dining room, a kitchen, 3 resident bedrooms, 2.5 bathrooms, a den, a laundry room and a attached garage. The facility is fire cleared for 6 non-ambulatory residents. On today's visit, all 12 domains, 4 resident and 5 staff files were reviewed. All 4 residents are receiving hospice services. The following were observed on today's visit: The dining room and living room have the appropriate furniture for 6 residents and was clean The fire place located in the living room was observed with a metal fire screen. The kitchen has the standard equipment - stove, refrigerator, toaster oven, coffee maker and dishwasher and was observed to be operational and clean. Knives are stored in a locked drawer. sufficient perishable and non-perishable foods were observed in the kitchen and in the garage Bedroom #1 and Bedroom #2 contained 2 hospital beds with full bed rails, 2 chairs,2 night stands, 2 lamps, a shared dresser, a shared closet and blinds for privacy. Located inside bedroom #1 is a private bathroom equipped with a shower stall, a toilet and a sink. Grab bars, a non-skid mat and a shower chair was observed. Water temperature was tested and read 116 degrees Fahrenheit. No window bars were observed in either bedroom. Bedroom #3 was observed with 2 hospital beds, 2 lamps, 2 night stands, 2 chairs and 1 shared dresser. The hospital bed to the back of the room was equipped with a full bed rail. The linen closet closet located by bedroom #1 was observed with extra linens, blankets and towels The half bathroom is equipped with a toilet and sink. Water temperature was tested and it read 116.2 degrees Fahrenheit. The common bathroom located closest to bedroom #3 was observed with a tub and shower, a toilet and a single sink. Grab bars and non-skid mat was observed. The water temperature was tested and it read 116.7 degrees Fahrenheit. Located by the common bathroom is the laundry room with a washer and dryer. Hygiene products and cleaning supplies were observed in the cupboards. Laundry room is locked. Located between bedroom #2 and #3 is the family room equipped with 2 sofas and a mounted television set. The only fire extinguisher purchased on 6/16/24 is located on the wall between the kitchen and dining room. The auditory devices mounted on the front door and the back door were operational. The first aid kit was reviewed and contained the required tweezer, scissors and thermometer. First aid manual was observed. The hardwired combination smoke/carbon monoxide detectors were tested and were operational. The backyard was observed with an umbrella and seating for outside activity. The backyard and the sides of the home were observed to be clean. The front yard was observed with a table and 2 chairs. The front yard was also observed to be clean. Trash cans located in the front were well maintained and were observed to be tightly sealed. The attached garage is used primarily for storage of extra beds, furniture and food supply. No deficiencies were cited on today's visit. Exit interview was conducted.the state’s words, verbatim · CDSS document, Aug 21, 2024