Our Sweet Home Inc. #3

Allegation investigated: Facility staff did not assist with medications as prescribed.

At 11:30am, Licensing Program Analyst (LPA) Angela Panushkina conducted subsequent complaint visit to deliver the final report. Upon arrival, the LPA was granted access to the facility by Staff #1 (S1). LPA contacted the Administrator, Tina Arutyunian, and explained the reason for the visit. LPA was infromed that the Administrator will not be able to come in and designated S1 to sign for the report. LPA requested residents and staff rosters. LPA also conducted a physical plant tour to ensure health and safety of the residents are protected. On 03/18/25, LPA initiated the complaint visit. During that visit LPA requested resident and staff roster. At 9:15am requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement, Appraisal Needs and Services Plan, Medication Policy, Centrally Stored Medication and Destruction Record (CSMDR), Medication Administration Record (MAR), Hospice Plan of Care, Continue on LIC9099-C Unsubstantiated Staff Training, relevant to the investigation. Between 9:30am - 10:30am, LPA conducted an interview with the Administrator, two (2) staff and attempted to interview five (5) out of five (5) residents. Additionally, LPA requested R1's Medical Records from Northridge Hospital and Convalescent Hospital/Skilled Nursing Facility (SNF). Allegation: Facility staff did not assist with medications as prescribed. To investigate this allegation, LPA conducted an interview with the Administrator, staff and residents. LPA also conducted reviews of R1’s Centrally Stored Medication and Destruction Records (CSMDR). Upon review of documentation, LPA observed that R1 was admitted to this facility on (08/11/2022) with the prescription of antipsychotic medication (50MG) and through review of medical documentation from 08/11/2022 to 01/18/2023, it appears that R1 was receiving their medication as prescribed. On 01/18/2023, the hospice physician increased R1’s antipsychotic dosage, adding a 100MG tablet at bedtime to the existing 50MG daily dose. After R1’s hospitalization from 02/11/2024 to 02/23/2024, the hospital physician discontinued the 50MG dose and continued only the 100MG antipsychotic medication once daily. Furthermore, R1’s records show that between 03/15/2024 – 05/31/2024, R1 was admitted to Rinaldi Convalescent Hospital and continued taking the prescribed medication during that time. R1’s antipsychotic medication was discontinued after their discharge on 05/31/24, based on the Convalescent Hospital physician’s order, and records confirmed it was not administered until a new hospice physician order was issued on 11/18/24. All documentation reviewed—including CSMDR records, physician orders, and medication logs—showed proper, accurate, and authorized administration. Medication checks for four (4) additional residents also showed no errors. Although there were concerns regarding hospice administration and prescribing authority, the investigation did not reveal evidence that facility staff failed to assist R1 with medications as prescribed. Based on interviews, records reviews and medications examined/inspected, there is insufficient evidence to support the above allegation. Therefore, this allegation is deemed Unsubstantiated, at this time. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jul 22, 2026 · control 31-AS-20250317085251

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Tuesday Cabiness conducted an unannounced annual inspection at the facility. LPA were greeted by the staff Sany Reyes, who granted access to the facility. LPA spoke to Administrator over the phone to inform her the reason of the visit. A physical plant inspection was conducted on the inside and outside. The following was observed: Common Areas: The facility maintains a comfortable temperature at 76°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Kitchen: The kitchen area and observed sufficient supplies of non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. There is a fire extinguisher was fully charged. Bedrooms: There are five (5) bedrooms designated for residents use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Alarms on all exit doors. Bathrooms: Bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 109.3°F. LPA observed appropriate grab bar and non-skid mat. All trash cans in bathrooms had fitted lids to protect from cross contamination. (Cont'd LIC809C) Medications: LPA observed medications are centrally stored and locked in the cabinet inaccessible to residents in care. LPA also observed a First Aid Kit complete with the required items as per regulations. Outside areas: Facility has a swimming pool that is fenced all around with a gate and kept locked at all times. The garage: Laundry area is located by the attached garage and kept locked and inaccessible to residents. Extra refrigerator with food. Record review: Resident and staff records appeared to be complete and updated. Smoke detectors/carbon monoxide: Operational. No citations issued, exit interview and copy of report provided to staff.the state’s words, verbatim · CDSS document, May 23, 2026

Type of visit: Required - 1 Year

At 9:30am, Licensing Program Analysts (LPAs) Angela Panushkina and Huma Rahimi arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPAs met with the Staff #1 who granted access to the facility. Administrator arrived shortly after, and LPAs explained the reason for the visit. At 9:35am LPAs conducted a tour of the physical plant and observed the following: Facility is licensed for capacity of six (6) of which five (5) may be Non-Ambulatory and one (1) bedridden residents. Facility also has a hospice waiver for four (4) residents. There are five (5) bedrooms designated for residents’ use, and one (1) bedroom, located by the kitchen area, is designated for live-in caregivers. Facility maintains a temperature of 75°F. LPAs observed there to be sufficient stock of one-week perishable foods and two-day non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. All knives were observed to be locked in the kitchen drawer. The fire extinguisher is located in the dining area and was last serviced on 9/24/2024. Medications and resident/staff files are kept in a metal cabinet, located in the dining area and kept locked and inaccessible to residents in care. There is a complete first-aid kit in the cabinet with all required supplies and with the first aid manual. Bedrooms are appropriately furnished and have appropriate lighting. Bathrooms have soap, paper towels and hand washing signs were observed. Bathrooms have soap, paper towels and all trash cans have a lid. Extra towels and linens were readily available. The hot water temperature measured at 113.5°F. Laundry is located in the garage. The washer/dryer appear to be in good condition. Laundry supplies, chemicals and detergents are kept in the garage and inaccessible to residents in care. Smoke detectors and carbon monoxide monitors were tested at 10:00am and observed to be functional. At 10:20am, LPAs observed appropriate outdoor furniture, with a covered shaded area for residents. LPAs also observed sufficient yard space with fenced backyard. The outdoor area was free of visible immediate hazards. LPAs discussed the importance of maintaining the care and supervision to meet the needs of residents. Continue on LIC809-C There is a swimming pool that is fenced with a gate that will be kept locked at all times. The fence installed to keep residents out of the swimming pool area is approximately 5 feet high throughout the parameters. You will need a key to unlock the padlock to gain entry to the swimming pool as it is kept locked at all times. Between 10:50am to 11:30am, LPAs reviewed records of five (5) residents and two (2) staff. Resident and staff records appeared to be complete and updated. Resident’s files contain signed admission agreements and a medical assessment, and all other required documentarians. LPAs were informed that the facility is no longer responsible for residents P&I Records. LPAs collected Certificate of Liability Insurance, Administrator Certificate and LIC500. No citations issued during this visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Mar 18, 2025

Type of visit: Required - 1 Year

At 12:30am, Licensing Program Analysts (LPAs) Perchui Milena Khurshudyan and Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPAs met with Staff #1, who granted access to the facility. LPAs explained the reason for the visit. At 12:45am LPAs conducted a tour of the physical plant and observed the following: Facility is licensed for capacity of six (6) of which five (5) may be Non-Ambulatory and one (1) bedridden residents. Facility also has a hospice waiver for four (4) residents. There are five (5) bedrooms designated for residents use, and one (1) bedroom, located by the kitchen area, is designated for live-in caregivers. Bedrooms are appropriately furnished and have appropriate lighting. Bathrooms have soap, paper towels and hand washing signs were observed. The hot water temperature measured at 114.0°F. Extra towels and linens were readily available. During the LPAs did not observe any immediate health and safety concerns. Facility maintains a temperature of 73°F. LPAs observed there to be sufficient stock of one-week perishable foods and two-day non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Sharps, cleaning supplies and medications are centrally stored and are kept locked in various kitchen cabinets and drawers. The fire extinguisher was observed in the kitchen area and was last purchased on 09/12/2023. Laundry is located by the kitchen, and LPAs observed all chemicals and detergents are kept locked and inaccessible to residents in care. LPAs observed a clean covered patio and backyard furniture to accommodate the six (6) residents. Smoke detectors and carbon monoxide monitors were tested at 1:20pm and observed to be functional. Between 1:30am to 2:00pm, LPAs reviewed records of five (5) clients and two (2) staff. Resident and staff records appeared to be complete and updated. LPA collected Certificate of Liability Insurance and LIC500. No citations issued during this visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Apr 12, 2024