Redell Pine

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sanjay Vaid conducted an unannounced annual inspection visit. LPA met with facility staff Jennie Ponce who allowed entry into the facility. Administrator was notified. The purpose of today's visit was discussed. The facility is licensed to serve (4) non-ambulatory and (2) bedridden, with a condition that the bedridden residents will stay in bedroom #2. LPA utilized the Compliance and Regulatory Enforcement tools for the visit today and observed the following: 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. 2. Operational Requirement: Liability Insurance is updated and in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place, policy expires 12/09/2026. 3. Physical Plant-This single-story home contains (3) bedrooms, (1) residents’ bathrooms, and (1) staff bathroom, living room, dining area, kitchen, laundry area, courtyard and detached garage. Resident rooms had the required furniture and in compliance. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was measured in a range from 106.4 degrees Fahrenheit. Adequate linen and personal hygiene supplies were observed. Medications were centrally stored, locked and inaccessible to residents in care. Auditory device alarms are operational. Smoke detectors and carbon monoxide detectors were tested and operable. Fire extinguishers were fully charged and replaced when needed. The outdoor area has a covered area and seating. (continued on 809C) 4. Staffing: The facility has sufficient staffing, and the night supervision staff have current CPR/first aid certification. 5. Personnel Record-Training: All the staff files are maintained in the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Some staff have required ongoing training. Administrator Ara Postaldjian Certificate expires 09/15/2027. 6. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, Pre-admission appraisal/Appraisal Needs & Services Plan. 7. Resident Rights-Information: The Complaint, ombudsman and CCLD poster are not posted. entry. Visiting hours are included in admission agreement. 8. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 9. Food Service: The kitchen was inspected and did have sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be very clean and sanitary. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents. 10. Incidental Medical and Dental: Medication is centrally stored and locked in the medication cabinet near the kitchen. Four (4) centrally stored resident medications were reviewed, which contained 30-day supply of medications. All medications are administered according to physician’s orders, 11.Disaster preparedness: The last fire drill was conducted on 03/2026, quarterly. The facility has an Emergency Disaster Plan posted at the facility. 12. Resident with Special Health Needs: One (1) resident is receiving home health services. Zero (0) resident is currently on postural support. Individual Service Plans and Appraisals are on file. Zero (0) deficiencies observed during today’s visit. An exit interview was held. A copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, May 12, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Bennette Pena conducted an announced Pre-Licensing facility evaluation visit. LPA met with Applicant/Licensee, Ara Postaldjian who assisted with the visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and the following was inspected during the evaluation. The physical plant was toured inside and out, and the following are observed: Physical Plant & Environment Safety: The facility is in a residential neighborhood in the city of Arcadia. This single-story home contains (3) bedrooms, (2) bathrooms, living room, dining area, kitchen, laundry area, courtyard and detached garage. Each bedroom has a smoke detector, bed, linen, dresser, light, chair and sufficient closet space. Smoke alarms and carbon monoxide were tested and operable. Facility has fire sprinklers also. Cleaning solutions, soaps, pesticides stored in a locked cabinet under the kitchen sink and stored separately from food supplies. Sufficient supply of linens available to permit weekly changing are available. Sufficient personal hygiene supply available. (1) fire extinguisher was observed to be fully charged and mounted on the wall in the dining area. Kitchen cabinets, refrigerator/freezer, oven, microwave, dishwasher, laundry machines are all brand new and in working condition. The home has an auditory device that will alert staff to monitor exits. Doors, exits, hallways, and passageways were clear and free of obstruction. No pools or bodies of water were observed in or around the property. There are no firearms present at the property. The home does not have a video camera monitor system inside and outside the property, except for the ring doorbell. There is an outdoor covered area that is furnished for outdoor use. Equipment and supplies for indoor activities was observed and available for use. Hot water temperature readings were within the Title 22 Regulations requirement. Operational Requirements: The Infection Control Plan has been submitted to CCL and the CAB Analyst. The facility has Infection Control Training Plan. The facility has a fire clearance granted by the City of Arcadia Fire Department. Fire clearance granted for (4) non-ambulatory and (2) bedridden, with a condition that the bedridden residents will stay in bedroom #2. Applicant stated that he will not handle residents' cash resources. Liability Insurance is in place. One (1) operating telephone was observed and tested by LPA on the premises. Telephone is easily accessible and available for residents' use. ***CONTINUED ON LIC 809-C***** Personnel Records-Training: Staff files will be maintained at the facility, which will be kept in a secured cabinet in the office located in the detached garage. Client Records-Incident Reports: Resident files will be maintained at the facility, which will be kept in a secured cabinet in the office located in the detached garage. Resident Rights-Information: Resident personal rights are posted. Facility provides internet service and phone to the residents. Planned Activities: The facility provides sufficient space to accommodate both indoor and outdoor activities. Food Service: Meals will be stored and prepared in a safe manner, necessary to meet the needs of the residents. Food storage and preparation areas, which include pantries, cupboards, drawers and counters were observed to be clean and appropriate for food preparation. Appliances such as a microwave, refrigerator and stove were observed to be brand new, clean and operating properly. The refrigerator was observed to be at 45 degrees Fahrenheit and the freezer at 0 degrees Fahrenheit. Health Related Services: The medications will be centrally stored in their original containers in a locked cabinet next to the kitchen. Disaster Preparedness: The home has a complete Emergency and Disaster Preparedness Plan. There is a contact information list of local emergency response personnel, residents authorized representative or local emergency contact name posted and visible to staff and residents. Component III was conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance. Facility met the physical plant requirements/ inspection as required. An exit interview was conducted, and a copy of this report has been furnished to the applicant, Ara Postaldjian. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, May 16, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): N/A COMP II Participants: Licensee/administrator ARA POSTALDJIAN Interview Method: Telephone interview On 5/6/2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, May 6, 2025