North Residential Care

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a continuation of the required annual visit at 01:40 PM. LPA met with facility staff who contacted facility Administrator Rebeka Durgaryan via telephone call. The facility Administrator arrived to the facility at 02:17 PM. Entrance interview conducted and the reason for the visit was explained. The following was observed: 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 conducted quarterly; the facility’s last emergency disaster drill was conducted on 04/08/2026. The facility’s emergency disaster plan is up to date but contained inaccurate information regarding the emergency supplies that were available at the facility. Both the infection control plan and the emergency disaster plan were reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed one (1) staff member. The staff member interviewed was knowledgeable on their role and responsibilities, resident rights, the different forms of abuse and the appropriate reporting procedures for suspected abuse. CONTINUED ON LIC 809C. RECORD REVIEW: Record review began at 02:22 PM. Resident records were reviewed for documents including, but not limited to: TB test, physician's report, needs and service appraisal, consent forms, and personal rights. Six (6) resident files were reviewed. LPA observed one (1) resident file to be missing proof of a negative tuberculosis (TB) test. LPA informed the Administrator who agreed to obtain proof of a negative TB test for the identified individual. MEDICATION REVIEW: Upon arrival to the facility LPA observed an unsecured bag of medications located on the infection control point at the entrance of the facility. Facility staff secured the bag of medications at the time of the visit. Medication review began at 02:52 PM. Medications are stored centrally in a cabinet in the living room. Medications for three (3) residents were observed. All three (3) resident’s centrally stored medication and destruction record sheets (CSMDRs) contained errors including incorrect dates filled/started, prescription numbers, and quantity of medications. Additionally, LPA observed six (6) medications to not be logged on their respective CSMDRs. During today’s visit LPA obtained a copy of the facility’s LIC 500, emergency disaster plan, resident roster, and 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, May 14, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(1)(C) · Plan of correction due date: May 14, 2026

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored... (C) Because of ...the condition or the habits of other persons in the facility... This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as a bag of prescription medications were left unsecured at the entryway infection control point which posed a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, May 14, 2026

Plan of correction: Staff secured the medications at the time of the visit. POC cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(6) · Plan of correction due date: May 28, 2026

87465 Incidental Medical and Dental Care (h) The following... shall apply... (6) ... a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above as three resident CSMDRs contained inaccurate information including date filled, prescription numbers, dates started, etc. which poses a potential health risk to persons in care.the state’s words, verbatim · CDSS document, May 14, 2026

Plan of correction: Administrator agreed to submit proof of accurate CSMDRs for the identified residents to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(c)(1)(A) · Plan of correction due date: May 28, 2026

87458 Medical Assessment (c) ... results of an examination for all of the following: (A) Communicable tuberculosis. This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as one resident file was observed to be missing proof of a negative TB test which poses a potential health risk to clients in care.the state’s words, verbatim · CDSS document, May 14, 2026

Plan of correction: Administrator agreed to submit proof of a negative TB test for the identified individual to CCLD no later than POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 01:21 PM. LPA met with facility staff who contacted facility Administrator Rebeka Durgaryan via telephone call. The facility Administrator arrived to the facility at 01:45 PM. Entrance interview conducted and the reason for the visit was explained. Beginning at 01:46 PM, the LPA, along with 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: BEDROOMS: There are five (5) bedrooms in the facility; three (3) are dual occupancy rooms, one (1) is a staff bedroom, and one (1) bedroom is unoccupied. LPA and facility Administrator toured all five (5) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Auditory alarms were observed on all facility exits and all were functioning at the time of inspection. The staff bedroom was observed to contain the facility’s emergency food and water supplies and was properly secured and inaccessible to clients in care. CONTINUED ON LIC 809C. BATHROOMS: There are three (3) bathrooms at the facility. Two (2) bathrooms are designated as shared resident bathrooms and one (1) is designated as a private resident bathroom. All bathrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Two (2) bathrooms were observed to contain secured cabinets that contained cleaning supplies, care supplies, and grooming supplies. Grab bars were observed in all showers and near all toilets, all were properly secured. The water temperature was measured to be between 108.1 and 118.2 degrees Fahrenheit, which is within the range required by regulation. COMMON AREAS: This included the living room, dining room, and hallways. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contained a couch, a television, an office area for the Administrator, a locked storage cabinet which contained resident medication, and activities for resident use. LPA observed all required postings for the facility located on the living room wall. The dining room was observed to be clean and contained adequate seating for resident use. Fire extinguishers were observed throughout the facility, and all were fully charged and purchased on 03/16/2026. Fire alarms and fire doors were tested three (3) separate times between 03:21 PM and 03:24 PM. On the first test the fire door separating the living room from the resident rooms failed to disengage the magnetic latch and properly close the door. The Administrator informed LPA that if the AC was running the latch would not disengage. The Administrator turned off the facility’s AC and tested the fire alarm again. On the second test the fire door successfully disengaged the magnetic latch but due to friction between the bottom of the door and the floor the door failed to close and left the passageway to the resident rooms mostly open. On the third attempt the alarm was tested and the facility fire door successfully closed. LPA notified the Administrator that the fire door failing to close due to friction and the use of the facility’s AC constitutes a violation of the facility’s fire clearance. LPA informed the Administrator that this is a zero-tolerance violation and an immediate civil penalty in the amount of $500 will be assessed on today’s date (04/16/2026). The Administrator agreed to contact a licensed professional to service the facility’s fire door and to send proof of the completed service to Community Care Licensing division (CCLD). LPA observed cameras throughout the common areas of the facility. The Administrator confirmed that the cameras are not active and do not record audio. CONTINUED ON LIC 809C. OUTDOOR SPACE: The facility had one (1) emergency exit gate located in the back yard. All railings located at the facility were secured properly. LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed two (2) windows at the facility to be damaged with large cracks across the glass. These windows were attached to the staff bedroom and one (1) shared resident bathroom. LPA informed the Administrator of the damaged windows. The Administrator agreed to perform repairs to the windows and to send proof of the completed repairs to CCLD. KITCHEN/LAUNDRY: 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 a secured lock box which contained knives. LPA observed the kitchen refrigerator to contain expired milk, yoghurt, and dressing. LPA informed the Administrator who threw away the identified items and agreed to conduct an audit of the facility’s food supplies to ensure no additional expired items are located at the facility. LPA observed the laundry to be located adjacent to the kitchen. LPA observed secured cabinets in the laundry which contained detergents and extra cleaning supplies. RECORD REVIEW: Record review began at 02:22 PM. Staff records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, and fingerprint clearance. Six (6) staff files were reviewed. LPA observed two (2) employees were hired at the facility on 04/07/2026. Staff are required to complete a total of forty (40) hours of training within the first year of employment and twenty (20) hours of this training must be completed before working independently with residents. LPA observed completed documentation of the forty (40) hours of training for the two (2) employees to be signed as completed on 04/07/2026. LPA asked the Administrator why forty (40) hours of training was documented as being completed on the same day. The Administrator stated that the trainings were completed across multiple days and the employees had signed their starting date on the training logs. LPA asked the Administrator what trainings were completed on the first day of employment. CONTINUED ON LIC 809C. The Administrator stated that the employees completed Alzheimer’s (6 hours), aging process (6 hours), techniques of personal care (4 hours), care of residents with dementia (6 hours), and abuse prevention (2 hours) for a total of twenty-four (24) hours of training completed on the first day. The Administrator stated that on the second day the employees completed trainings on postural supports (2 hours), hospice (1 hour), Spiritual and psychosocial care (2 hours), medication training (8 hours), care of bedridden persons (1 hour), advanced directives (1 hour), and personal rights (2 hours) for a total of seventeen (17) hours of training completed on the second day. The Administrator stated that on the third day of training the employees completed training on disasters (2 hours), fall prevention (2 hours), prohibited health conditions (2 hours), and advanced directives (1 hour) for a total of seven (7) hours of training on the third day. LPA informed the Administrator that the logs of completed trainings need to accurately reflect the date of attendance. The Administrator expressed understanding and agreed to submit a true and accurate record of trainings for the two (2) identified staff members to CCLD. INTERVIEWS: LPA interviewed two (2) residents. Both residents interviewed stated that the staff treat them well and are attentive to their needs. No residents interviewed had concerns with the facility. Due to time constraints LPA will return at a later date to conduct interviews with staff, a resident file review, a medication review, a review of the facility’s emergency disaster plan and infection control plan, and to obtain copies of facility documents. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited and civil penalty assessed (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 16, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.149 · Plan of correction due date: Apr 17, 2026

§1569.149 Fire clearance approval... ... the facility shall secure and maintain a fire clearance approval from the local fire enforcing agency... This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as the facility's fire door failed to close on two separate tests of the facility's fire alarm system which poses an immediate safety risk to clients in care.the state’s words, verbatim · CDSS document, Apr 16, 2026

Plan of correction: Administrator agreed to contact a licensed professional to service the facility's fire door to ensure proper operation. Licensee agreed to submit proof of the completed service and proof of the functioning fire door to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Apr 30, 2026

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times.... This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as two facility windows had large cracks across the glass which poses a potential safety risk to clients in care.the state’s words, verbatim · CDSS document, Apr 16, 2026

Plan of correction: Administrator agreed to replace the two damaged windows and to send proof of the completed replacement to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(8) · Plan of correction due date: Apr 30, 2026

87555 General Food Service Requirements (b) The following food service requirements shall apply: (8) All food shall be of good quality... This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as the facility's refrigerator contained expired milk, yoghurt, and dressing which posed a potential health risk to clients in care.the state’s words, verbatim · CDSS document, Apr 16, 2026

Plan of correction: The Administrator threw away the expired items at the time of the visit. Administrator agreed to conduct an audit of all of the facility's food supplies to ensure no additional expired items are stored at the facility. Administrator agreed to submit proof of the completed audit to CCLD no later than... ... POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(c)(2)(C) · Plan of correction due date: Apr 30, 2026

87412 Personnel Records (c) Licensees shall maintain in the personnel records... (2) Documentation of staff training shall include: (C) Date(s) of attendance... This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as the facility did not accurately record the dates of attendance to mandatory trainings for two facility staff members which poses a potential health, safety, or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Apr 16, 2026

Plan of correction: The Administrator agreed to submit a true and accurate record of trainings completed for the two (2) identified staff members to CCLD no later than POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:32 AM. LPA met with facility staff who contacted facility Administrator Rebeka Durgaryan via telephone call. The facility Administrator arrived to the facility at 09:52 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:53 AM, the LPA, along with 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: COMMON AREAS: This includes the living room, dining room, and hallways. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contains a couch, a television, an office area for the Administrator, a locked storage cabinet containing resident medication, and activities for resident use. The dining room was observed to be clean and contained adequate amounts of seating for resident use. LPA observed all required postings for the facility located on the living room wall. Fire extinguishers were observed throughout the facility, and all were fully charged and purchased on 02/11/2025. Fire alarms, fire doors, and carbon monoxide alarms were tested at 12:06 PM and functioned properly at the time of inspection. LPA observed cameras throughout the common areas of the facility. The Administrator confirmed that the cameras are not active and do not record audio. Continued on LIC 809C. BEDROOMS: There are five (5) bedrooms in the facility; one (1) is a single occupancy room, two (2) are dual occupancy rooms, one (1) is a staff bedroom, and one (1) bedroom is unoccupied. LPA and facility Administrator toured all five (5) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Auditory alarms were observed on all facility exits and all were functioning at the time of inspection. The staff bedroom was observed to contain the facility’s emergency food and water supplies and was properly secured and inaccessible to clients in care. BATHROOMS: There are three (3) bathrooms at the facility. Two (2) bathrooms are designated as shared resident bathrooms and one (1) is designated as a private resident bathroom. All bathrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Two (2) bathrooms were observed to contain secured cabinets that contained cleaning supplies and grooming supplies. Grab bars were observed in all showers and near all toilets, all were properly secured. The water temperature was measured between 108.9 and 117.3 degrees Fahrenheit, which is within the range required by regulation. KITCHEN/LAUNDRY: The LPA observed the kitchen area to be clean. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured lock box to contain knives. LPA observed the laundry to be located adjacent to the kitchen. LPA observed secured cabinets in the laundry to contain detergents and extra cleaning supplies. OUTDOOR SPACE: The facility has one (1) emergency exit gate located in the back yard. All railings located at the facility were secured properly. LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. Continued on LIC 809C. RECORD REVIEW: Record review began at 10:33 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, first aid certification, consent forms, and personal rights. Five (5) staff files were reviewed. All staff files contained the required documentation and trainings. Five (5) resident files were reviewed. One (1) resident was identified by their physician to be a bedridden resident. LPA spoke with the resident who confirmed that they were unable to reposition without staff assistance. LPA confirmed that the facility’s fire clearance does not permit them to admit bedridden residents. LPA informed the Administrator that admitting bedridden clients is a violation of their fire clearance and poses an immediate safety risk to clients in care. LPA informed the Administrator that this is a zero-tolerance violation and an immediate civil penalty in the amount of $500 will be assessed on today’s date (04/09/2025). The Administrator expressed understanding and confirmed that the resident would be relocated to a licensed facility that has an appropriate fire clearance to care for bedridden residents. MEDICATION REVIEW: Medication review began at 12:38 PM. Medications are stored centrally and securely in a cabinet in the living room. Medications for three (3) residents were observed. All medications observed were documented appropriately on their centrally stored medication and destruction record sheets and their Medication Administration Record sheets. No deficiencies were observed during medication review. 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 it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 01/30/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan were reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed one (1) staff and three (3) residents. All residents interviewed stated that the staff treat them well and are attentive to their needs. No residents interviewed had concerns with the facility. The staff member interviewed was knowledgeable on their role and responsibilities, resident rights, the different forms of abuse and the appropriate reporting procedures for suspected abuse. Continued on LIC 809C. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency and civil penalty 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 9, 2025

The state marks this report as 9 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:50 a.m., the LPA met with staff and explained the reason for it visit. At 10:16 a.m., the Administrator arrived at the facility. At 10:21 a.m., the LPA, along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. At 10:10 a.m., the LPA conducted an interview with one (1) out of six (6) residents. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked safety box found on top of the kitchen counter. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:39 a.m., hot water measured at 110.0-degree Fahrenheit. BEDROOMS: The facility is a single-story residential home with five (5) bedrooms, four (4) for resident use and one (1) for staff use. 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: The facility has three (3) bathrooms for resident's use. Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 10:30 a.m., hot water measured between 106.3 and 112.6-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. OUTDOOR SPACE: At 10:33 a.m., the LPA observed the back and side 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. The garage is attached and remains inaccessible to residents. Passageways were free and clear from obstruction. There are no bodies of water on the premises. Continued on LIC-809-C. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguishers to be fully charged and last purchased on 10/15/2023. At 2:06 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Night lights were present in the hallways and passages. All exits have functioning auditory devices and were operational at the time of the visit. First aid kit is located near the front entrance. Medications are stored in locked cabinet located between the kitchen and common areas. The LPA observed cameras in the common areas. RECORD REVIEWS: Between 10:47 a.m. and 12:30 p.m., the LPA conducted a file review for all residents and staff regularly scheduled. Staff records were reviewed for documents including, but not limited to health screening, TB test, staff training records, and fingerprint clearance. Staff have current first aid and training appeared to be completed. Resident records were reviewed for, but not limited to care plans, medical assessments, admissions agreement, consent forms. The following was noted: One (1) out of two (2) residents with dementia diagnosis did not have updated physician’s report/ medical assessments. Technical violation issued and discussed with Administrator. Three (3) out of six (6) residents require updated appraisals/needs and service plan. Three (3) out of six (6) residents need assistance/ depend on others to perform all activities of daily living (ADLs). The LPA had a discussion with the Administrator regarding Prohibited Health Conditions. Facility fire drill was last conducted on 01/08/2024 and disaster drill was last conducted on 01/10/2024. Administrator certificate is current and valid until 02/03/2026. Due to time constraints the LPA will return to complete the annual at a later date. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8 and California Health and Safety Code the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted. The Administrator authorized staff, Svetlana Petrosian to sign the report. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 17, 2024