Prime Residential Senior Care

Type of visit: Required - 1 Year

At 9:45 AM Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the staff Nora Karapatyan and the Administrator was contacted via telephone. LPA explained the reason for the visit. Physical tour was conducted with the Administrator and LPA observed the following: Kitchen: At 9:55 AM LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen drawer. LPA observed a fire extinguisher hanging on the wall by the kitchen and was purchased on 04/27/2026. Medications: At 10:00 AM LPA observed medications are centrally stored and locked in a closet in the hallway and inaccessible to residents in care. During the medication review, LPA could not verify the accuracy of the medication administration due to the lack of incomplete Centrally Stored Medication Record (CSMR) Form. Administrator informed LPA that the Administrator did not complete the form and was unable to provide a reason. Bedrooms: The facility has six (6) bedrooms in total. All bedrooms were clean and odorless. Furniture was in good repair. Bedroom #3 was designated for a bedridden resident. One of the bedrooms located near the kitchen is designated for staff and LPA observed free of hazard and obstruction. LPA observed full bed rails for Resident #5 (R5), in bedroom #2 without Physician's order on file. Continue on LIC 809C Bathrooms: The facility had 3 bathrooms. Bathrooms #1 located by the entrance is designated for staff. All bathrooms contained paper towels and liquid soap. Bathroom #3 is attached to bedroom #6. Bathrooms have grab bars and a non-skid mat. Hot water temperature measured at 119.8°F. Common Areas: The facility maintains a comfortable temperature at 70°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. Garage: LPA observed the garage to be locked and inaccessible to residents in care where the facility kept cleaning supplies, hazardous liquids, detergents, and extra PPE accessible to residents in care. LPA observed an extra refrigerator for staff and residents. Laundry: The laundry is located between the kitchen and garage. LPA observed the laundry to be locked and inaccessible to residents in care. Outside and Back Yard: LPA toured the two side paths and back yard. Both emergency exit gates were unlocked, and paths were free from debris. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 10:00 AM, they were tested and observed to be operational. Carbon monoxide was living room and was also tested and observed to be operational. LPA heard functioning auditory alarms on all exit doors. Between 11:00 AM to 1:30 PM, LPAs reviewed records of six (6) residents, two (2) staff, and the Administrator. R2's file was missing Appraisal Needs and Services Plan (LIC 625), R3's LIC 625 was last updated on 02/05/2025. R5's LIC 625 was last updated on 02/05/2025. Staff records/files were completed and updated. On 04/15/2026, the LPA was notified via email by a credible witness of ongoing construction work on the facility’s roof. The LPA subsequently contacted the facility’s Administrator by telephone, who confirmed that the construction was being conducted due to a leak. The Administrator also confirmed that the Regional Office had not been notified prior to the construction or modification of the facility’s roof. Continue on LIC 809C Administrative: LPA collected Certificate of Liability Insurance, and LIC500. Deficiencies cited during today’s visit. Appeal rights issued and given. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Apr 27, 2026

Type of visit: Required - 1 Year

At 9:30 AM Licensing Program Analysts (LPAs), Huma Rahimi and Nadia Shabazian, conducted an unannounced annual inspection at the facility mentioned above. LPAs met with the staff Anahit Zohrabyan and later Administrator Sofya Khechikyan arrived and explained the reason for the visit. Physical tour was conducted with the Administrator and LPAs observed the following: The total capacity of the facility is approved for six (6) residents; however, LPAs observed seven (7) residents. LPAs were informed that one (1) of the residents is their family member. Kitchen: At 9:45 AM LPAs toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen drawer. LPAs observed a fully charged fire extinguisher hanging on the wall by the kitchen purchased on 02/03/2025. Medications: At 9:50 AM LPAs observed medications are centrally stored and locked closet in a hallway. Additionally, LPAs observed Hydrocortisone Ointment 2.5% in the kitchen drawer unlocked and as well as other medication and ointments in residents bedrooms unlocked and accessible to residents in care. Furthermore, at 2:30 PM, during the medication review for six (6) out of six (6) residents, LPAs could not verify the accuracy of the medication administration due to the lack of incomplete Centrally Stored Medication Destruction Form. Administrator informed LPAs that the Administrator did not complete the form and was unable to provide a reason. Bedrooms: The facility has six (6) bedrooms in total. All bedrooms were clean and odorless. Furniture was in good repair. Bedroom #3 was designated for a bedridden resident, and the emergency exit was free from obstruction. Bedroom #6 is shared and one of the resident is a family member of the Administrator who requires full assistance with daily living. One of the bedrooms located near the kitchen is designated for staff and LPAs observed free of hazard and obstruction. LPAs also observed medication accessible to residents in their bedrooms. Continue on LIC 809C Bathrooms: The facility had 3 bathrooms. Bathrooms #1 located by the entrance is designated for staff and LPAs observed a small cabinet with an Antibiotic Pain Ointment and Vicks accessible to residents in care. All bathrooms contained paper towels and liquid soap. Bathroom #3 attached to bedroom #6 has a trash can without tight fitting lid and as well LPAs observed scissors accessible to residents in care. Bathrooms have grab bars and a non-skid mat. Hot water temperature measured at 119.8°F. Common Areas: The facility maintains a comfortable temperature at 75°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. Garage: LPAs entered an unlocked garage and saw more cleaning supplies, hazardous liquids, detergents, and extra PPE accessible to residents in care. LPAs observed an extra refrigerator for staff. Laundry: The laundry is located between the kitchen and garage. LPAs observed an unlocked laundry detergent accessible to residents in the laundry room. Staff admitted to LPAs that they forgot to lock it away after using it this morning. Outside and Back Yard: LPAs toured the two side paths and back yard. Both emergency exit gates were unlocked, and paths were free from debris. LPAs observed appropriate outdoor furniture, with a covered shaded area for residents. LPAs observed gardening tools and a full can of paint accessible to residents in care. Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 10:00 AM, they were tested and observed to be operational. Carbon monoxide was living room and was also tested and observed to be operational. LPAs heard functioning auditory alarms on all exit doors. Between 12:00 PM to 2:30 PM, LPAs reviewed records of four (4) residents and two (2) staff. Resident files were not updated/completed. Staff records and training were not updated and completed. . During the interview with the Administrator LPAs were informed that one of the residents (R5) passed away on 09/05/2024. On or about 09/01/2024, R5 was taken to the hospital due to breathing problem and R5 passed away in the hospital. LPAs reviewed all incident and death reports in the system and did not observe any Incident or death reports regarding R5. Continue on LIC 809C In addition, the Administrator admitted that no incident or death reports were submitted to the Regional Office (RO) since the Administrator forgot to submit an incident and death reports to the department. Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPA informed the Administrator that all staff members are mandated reporters and they are all responsible for reporting. Deficiencies cited during today’s visit. Appeal rights issued and given. Exit interview conducted and copy of this report signed and delivered. Administrative: LPAs collected Certificate of Liability Insurance, and LIC500.the state’s words, verbatim · CDSS document, Feb 3, 2025

Type of visit: Required - 1 Year

At 9:45 AM Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the staff Anahit Zohrabyan and later Administrator Sofya Khechikyan arrived and explained the reason for the visit. Physical tour was conducted with the Administrator and LPA observed the following: Kitchen: At 10:21 AM LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. LPA observed multiple scissors in two different drawers of the kitchen unlocked and available to residents in care. Toxin (comet) under the sink cabinet were observed unlocked and accessible to residents in care. Medications: At 10:26 AM LPA observed medications are centrally stored and locked closet in a hallway amongst bedrooms # one (1), and # two (2), and three (3). The locked closet also contained residents and staff files. Additionally, LPA observed over the counter stomach relief medication unlocked and accessible to residents in the kitchen cabinet. Injectable diabetes medications for a resident were observed unlocked in the refrigerator in the kitchen. Bedrooms: The facility has six (6) bedrooms in total. Bedroom # one (1), and bedroom # five (5) are shared. In bedroom # five (5), a relative of the administrator lives who is fingerprint cleared. Bedrooms # two (2), three (3), and four (4) are private. All bedrooms were clean and odorless. Furniture was in good repair. Bedroom #3 was designated for a bedridden resident, and the emergency exit was free from obstruction. One of the bedrooms located near the kitchen is designated for staff and LPA observed free of hazard and obstruction. LPA also observed a scissor in a resident bedroom # four (4). A knife was accessible in a shared bedroom # five (5). Continue on LIC 809C Bathrooms: The facility had 3 bathrooms. Bathrooms #1 and #2 were located at the front. They contained paper towels, liquid soap, and trash cans with tight fitting lids. Bathroom #3 was connected to Bedroom #4. It contained liquid soap, paper towels, a lidless trash can, and a shower with grab bars and a non-skid mat. Hot water temperature measured at 119.3°F. Common Areas: The facility maintains a comfortable temperature at 73°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. Garage: LPA entered a locked garage and saw more cleaning supplies, hazardous liquids, detergents, extra PPE, and a refrigerator for extra food for staff. Laundry: The laundry is located between the kitchen and garage. LPA observed an unlocked laundry detergent accessible to residents in the laundry room. Staff admitted to LPA that they forgot to lock it away after using it this morning. Outside and Back Yard: LPA toured the two side paths and back yard. Both emergency exit gates were unlocked, and paths were free from debris. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. The back yard contained a gardening space. Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 10: 44 AM, they were tested and observed to be operational. Carbon monoxide was living room and was also tested and observed to be operational. LPA heard functioning auditory alarms on all exit doors. Between 12:20 AM to 3:30 AM, LPA reviewed records of six (6) residents and two (2) staff. Residents and staff records appeared to be complete and updated. Deficiencies cited during today’s visit. Appeal rights issued and given. Exit interview conducted and copy of this report signed and delivered. Administrative: LPA collected Certificate of Liability Insurance, and LIC500.the state’s words, verbatim · CDSS document, Feb 26, 2024