Rose Garden Senior Housing

Allegation investigated: Staff are not providing meals to a resident in care. Staff damaged resident’s personal property.

Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 02:04 PM to conduct a follow-up complaint investigation visit at the facility today. LPA met with facility staff who contacted Administrator Lilit Tonoyan. The Administrator arrived to the facility at 02:32 PM. Entrance interview was conducted and the reason for the visit was explained. On 04/03/2026 LPA conducted a physical plant tour, conducted a file review for four (4) residents, obtained copies of pertinent documentation, interviewed one (1) resident, one (1) staff member, the Administrator, and attempted to interview one (1) additional resident between approximately 10:00 AM and 02:40 PM. On 07/09/2026 LPA conducted a physical plant tour, conducted a file review for three (3) residents and one (1) staff member, obtained copies of pertinent documentation, and conducted a medication review for three (3) residents between approximately 10:15 AM and 02:40 PM. On 07/30/2026 LPA conducted a physical plant tour, interviewed one (1) resident, one (1) staff member, the Designee, and attempted to interview one (1) witness between approximately 10:18 AM and 03:00 PM. CONTINUED ON LIC 9099C. Unsubstantiated During today’s visit LPA conducted a physical plant tour, interviewed two (2) residents, one (1) staff member, and delivered findings between approximately 02:15 PM and 04:00 PM. The allegation of “Staff are not providing meals to a resident in care” alleges that Witness #1 (W1) had to pay out of pocket for their own meals as the facility only provided Armenian/Russian Meals that did not work with W1’s dietary restrictions and that the meals that were provided were always over/under cooked. LPA interviewed W1 who stated that the facility would not cook meals that adhered to their dietary restriction and no alternative meals were provided to them. W1 stated that as a result they were forced to pay approximately $800 per month to purchase their own food. LPA conducted a physical plant tour of the facility on 04/03/2026, 07/09/2026, 07/30/2026, and 08/11/2026 and on each tour observed the facility to have a sufficient supply of two (2) days perishable and seven (7) days of non-perishable food. LPA interviewed Staff #1 (S1) who stated that the facility provides a variety of meals to the residents of the facility and alternatives are made available if a resident does not want what is being served. S1 stated that they are aware of the residents dietary restrictions and S1 was able to appropriately identify current resident’s dietary restrictions. S1 identified that W1 had a dietary restriction and stated that the facility had provided food items that were consistent with W1’s diet but W1 often purchased their own meals rather than eating what the facility had offered them. LPA interviewed the Administrator who stated that the facility had purchased food items specific to W1’s dietary restrictions however, W1 still purchased their own food items from outside of the facility. The Administrator stated that alternative meals were offered to W1 and other facility residents if they did not want the meal that was being served. During the investigation W1 provided LPA with bank and credit card statements from the time they resided at the facility. W1 indicated on the statements each time they purchased items and stated that these purchases were made due to the facility not providing meals. LPA reviewed the statements and only observed dollar amount totals. LPA did not observe any receipts showing that the items purchased were food items compliant with W1’s diet. LPA interviewed two (2) facility residents. The two (2) residents interviewed did not have concerns with the quality or quantity served at the facility. Resident #1 (R1) stated that they have a dietary restriction and the facility does their best to provide meals that are accommodating to their diet. Both residents stated that meals are always offered and denied the facility ever failing to provide meals to residents. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff are not providing meals to a resident in care.” Therefore, the allegation is deemed Unsubstantiated at this time. CONTINUED ON LIC 9099C. The allegation of “Staff damaged resident’s personal property” alleges that Staff #2 (S2) dropped and broke W1’s television when W1 was moving into the facility. LPA interviewed W1 who stated that upon move-in to the facility S2 had informed them that Witness #2 (W2) had dropped their television and broken the item. W1 stated that upon move out they spoke with W2 who informed W1 that S2 was the individual who had dropped the television and damaged the item. W2 informed LPA that when W1 was moving into the facility they had unloaded the television inside of it’s box and placed the box onto the ground. W2 stated that S2 made contact with the box and knocked it over. W2 stated that after attempting to plug the television in the device was not working so they believed that was how the television was damaged. LPA interviewed S2 who denied ever making contact with the television or its box and denied causing damage to the television. S2 stated that they had opened the box to assist in setting up the television and observed a large crack across the screen. S2 stated that the box contained no padding or protective material to cushion the television during transport. S2 stated that they notified W1 of the damage to the television at the time of move-in. LPA interviewed two (2) facility residents. Both residents stated that facility staff are respectful about their personal belongings. Both residents denied any personal belongings being damaged by facility staff. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff damaged resident’s personal property.” Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 11, 2026 · control 29-AS-20260327153057

Allegation investigated: Staff did not administer medication to a resident in care. Staff verbally abused a facility resident. Staff overcharged a resident in care.

Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 10:16 AM to conduct a follow-up complaint investigation visit at the facility today. LPA met with facility staff who contacted the Designee Hasmik 'Jasmine' Khachatryan. The Designee arrived to the facility at 10:50 AM. Entrance interview was conducted and the reason for the visit was explained. On 04/03/2026 LPA conducted a physical plant tour, conducted a file review for four (4) residents, obtained copies of pertinent documentation, interviewed one (1) resident, one (1) staff member, the Administrator, and attempted to interview one (1) additional resident between approximately 10:00 AM and 02:40 PM. On 07/09/2026 LPA conducted a physical plant tour, conducted a file review for three (3) residents and one (1) staff member, obtained copies of pertinent documentation, and conducted a medication review for three (3) residents between approximately 10:15 AM and 02:40 PM. During today’s visit, the LPA conducted a physical plant tour, interviewed one (1) resident, one (1) staff member, the Designee, and attempted to interview one (1) witness between approximately 10:18 AM and 03:00 PM. CONTINUED ON LIC 9099C. Substantiated The allegation of “Staff did not administer medication to a resident in care” Alleges that the facility mismanaged Witness #1 (W1)’s medications. LPA interviewed W1 who stated that the facility had mismanaged their medications by not informing W1 when they had run out of medications, by giving W1 someone else’s medications, by administering W1’s medications incorrectly and not as prescribed, and by withholding W1’s medications for hours prior to W1 leaving the facility. LPA interviewed the Administrator and asked why W1’s medications were withheld from W1 when they were leaving the facility. The Administrator explained W1 had asked for their medications the day prior to them leaving so they could pack them with their belongings. The Administrator stated they informed W1 that medications needed to remain locked up in a secure location and that they would provide the medications to W1 once their responsible party arrived to the facility the next day. The Administrator stated the next day the W1’s responsible party came to the facility and all medications that were present at the facility were handed over to the responsible party. On 07/09/2026 LPA conducted a medication audit for three (3) current facility residents. During the Audit LPA observed multiple discrepancies in the current pill counts and how many pills should be remaining in the bottles. Additionally, LPA reviewed the Centrally Stored Medication and Destruction Record Sheets (CSMDRs) for the three (3) residents and observed discrepancies between what was listed on the CSMDRs and on the prescription labels including: dosage of the medication, pill count, and prescription numbers. LPA interviewed the Administrator telephonically and asked why there were discrepancies observed during the audit. The Administrator was unable to explain why the pill counts were incorrect or why there were errors on the CSMDRs. The Administrator stated that they may have incorrectly counted the amount of pills that were originally in the bottle when received by the facility. Based on the information obtained during interviews and file review there is sufficient evidence to support the allegation of “Staff did not administer medication to a resident in care.” Therefore, the allegation is deemed Substantiated at this time. The allegation of “Staff verbally abused a facility resident” Alleges that facility staff yelled and screamed at Resident #1 (R1) while at the facility. LPA interviewed W1 who stated that their room was near R1’s room and they had overheard facility staff yelling at R1 previously. LPA interviewed R1 who informed LPA that they have had a problem with facility staff “hollering” at them previously. R1 stated that they yelling occurred after a bout of incontinence which caused Staff to raise their voice and be mad at them. R1 stated that staff had yelled that they had already cleaned the facility three times that day. R1 stated that the Administrator talked to the staff member and since then the staff have been very nice and kind to R1. CONTINUED ON LIC 9099C. LPA interviewed the Administrator who stated they have trained all facility staff to be kind to the residents of the facility. The Administrator denied any staff ever raising their voice or yelling at the residents of the facility. The Administrator stated they did have a conversation with a staff member regarding the tone of their voice. The Administrator stated they had the conversation because they understand that the staff’s tone it may be interpreted as sounding harsher than it is meant to be. The Administrator denied ever disciplining facility staff for yelling at any residents of the facility. Based on the information obtained during interviews there is sufficient evidence to support the allegation of “Staff verbally abused a facility resident.” Therefore, the allegation is deemed Substantiated at this time. The allegation of “Staff overcharged a resident in care” Alleges that the facility had charged W1 $1,700 /month however W1 was an SSI/SSP recipient and was overcharged. Additionally, the allegation alleges that the facility did not provide a notice to W1 when raising the monthly payment from $1,700 to $2,300 /month. LPA interviewed W1 who stated that the facility verbally informed W1 that they would be raising the rent by $600 /month or W1 would have to leave the private room that they had been moved in to. W1 stated that they had paid the increased amount to the facility for three (3) months before contacting their representative and informing the facility that they were being overcharged. W1 stated that after raising the issue with the facility they were refunded the full amount of $1,800 that they were overcharged for the previous three (3) months. LPA interviewed the Administrator who explained that W1’s rent at the facility was always $1,700 and there was no increase for W1. The Administrator stated that W1 was placed at the facility with the assistance of a long-term geriatric care consulting agency which was assisting in covering some of the rent for the facility. The Administrator stated that the actual cost for W1’s rent at the facility was approximately $5,600 but W1 only paid $1,700 of that amount each month. The Administrator stated that there was an issue with the agency providing their portion of the rent to the facility and during that time W1 was charged $2,300 /month for staying at the facility. The Administrator stated that no written notice was given to W1 or W1’s responsible party about the increase but they were both verbally informed of the increase prior to the implementation of the new rate. CONTINUED ON LIC 9099C. LPA reviewed W1’s admission agreement and observed the section titled “Funding Source”. LPA observed the line where the resident’s funding source is disclosed to be blank. However, LPA observed “1700” written on the line which states “does include SSI/SSP funds. Additionally, LPA observed the admission agreement to contain the following, “The facility does not accept SSI/SSP-dependent residents and cannot accept SSI/SSP-issued Personal and Incidental Needs monies as higher payment for services. Facility does not accept voluntary contributions from others as payment. Failure to reveal to the facility the SSI status of the resident may void this contract.” Based on the information obtained during interviews and file review there is sufficient evidence to support the allegation of “Staff overcharged a resident in care.” Therefore, the allegation is deemed Substantiated at this time. This report was read to the Administrator via telephone call. The following deficiencies were cited (refer to LIC 9099D). A copy of the report and appeal rights were provided, and exit interview was conducted. The allegation of “Staff did not dispose of trash” alleges that the trash in Witness #1 (W1)’s room was not emptied in a timely manner and W1 had to constantly ask facility staff to empty the trash can. LPA interviewed Resident #1 (R1) who informed LPA that the facility is always very clean and facility staff members are always cleaning. LPA observed the private resident bedroom of the facility during visits on 10/06/2025, 04/30/2026, 07/09/2026, and 07/30/2026. On all four (4) occasions the private resident bedroom appeared to be clean and in good repair. Additionally, on all four (4) occasions LPA observed the remainder of the facility to be clean and in good repair. LPA interviewed the Administrator and facility staff who informed LPA that W1 had placed a “Do not enter” sign on the door to the bedroom while they resided at the facility. The Administrator and staff stated that when staff attempted to clean the room W1 would become verbally aggressive with staff which sometimes led to delays in the cleaning of R1’s room. The Administrator and staff stated that despite the delays W1’s room was cleaned daily and denied any substantial buildup of trash in W1’s room. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff did not dispose of trash.” Therefore, the allegation is deemed Unsubstantiated at this time. The allegation of “Staff is unable to effectively communicate with residents in care” alleges that facility staff are unable to effectively communicate with residents in care due to a language barrier. On 04/03/2026 LPA interviewed facility staff #1 (S1) via telephonic translation services for clarity and to ensure no information was missed while investigating allegations related to this complaint. During the interview S1 was able to demonstrate appropriate understanding of both verbal and written English. LPA provided S1 with an example of medication administration instructions written in English. S1 was able to appropriately read the instructions and appropriately explained the dosage instructions back to LPA. On 07/30/2026 LPA interviewed S1 again without the use of interpretation services. During this interview S1 stated that although they can still struggle to respond fluently in English, they understand English well and are able to respond to resident’s requests. S1 stated that they have been taking English proficiency classes for the last two (2) months and utilize translation apps when needed. Additionally, S1 was able to appropriately respond when LPA provided examples of common requests including asking for water, asking for food, telling S1 it was time for medications, and when asking for assistance with transferring. CONTINUED ON LIC 9099C. LPA interviewed the Administrator who informed LPA that although S1 did not speak English well they are able to understand the residents of the facility and provide for their needs. The Administrator stated that Google Translate is utilized to help ease any communication issues between S1 and residents. The Administrator stated that S1 is studying English proficiency and is improving their English communication skills. LPA interviewed R1 during today’s visit. R1 stated that although they had some problems with communicating with facility staff previously S1’s English proficiency has greatly increased since they came to the facility. R1 stated that they have no concerns with the ability of S1 to communicate with residents of the facility at this point. LPA interviewed the Designee who stated that both they and the Administrator are always available via telephone call in the event of an emergency if S1 is unable to communicate with emergency personnel. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff is unable to effectively communicate with residents in care.” Therefore, the allegation is deemed Unsubstantiated at this time. This report was read to the Administrator via telephone call. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 30, 2026 · control 29-AS-20260327153057

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87456(a)(4) · Plan of correction due date: Aug 13, 2026

87465 Incidental Medical and Dental Care (a) ... by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interviews and record review the Licensee did not comply with the section cited above as during a medication audit discrepancies were observed between the pill counts and info recorded on the CSMDR which poses a potential health risk to clients in care.the state’s words, verbatim · CDSS document, Jul 30, 2026

Plan of correction: Administrator agreed to submit a signed statement of understanding confirming that they are aware of the importance of accurately logging medications and that they will appropriately log all medications in a timely manner. Administrator agreed to submit the statement to CCLD no later than... ...the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Aug 13, 2026

87468.1 Personal Rights of Residents... (a) ... shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff... This requirement is not met as evidenced by: Based on interviews the Licensee did not comply with the section cited above as S1 spoke inappropriately towards R1 previously at the facility which posed a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jul 30, 2026

Plan of correction: S1 received a training on how to appropriately address facility clients. Facility clients reported that S1 has not spoken inappropriately towards them since the issue was addressed. POC cleared.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655(a) · Plan of correction due date: Aug 13, 2026

§1569.655 Increase in fee rates... (a) If a licensee... increases the rates of fees for residents ...shall provide no less than 90 days’ prior written notice to the residents or the residents’ representatives... This requirement is not met as evidenced by: Based on interview and record review the Licensee did not comply with the section cited above as W1 was charged an increased rate from the original agreed upon amount without prior written notice which poses a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jul 30, 2026

Plan of correction: Administrator agreed to submit a signed statement of understanding confirming that they are aware of, and will comply with the required notification timeframe and requirements for all future rate increases. Administrator agreed to submit the signed statement to CCLD... ...no later than POC due date.

The state marks this report as 11 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Allegation investigated: Staff made changes to the facility without notifying licensing. Staff did not maintain a comfortable temperature for residents in care. Staff did not ensure that resident's bathroom is kept clean. Facility did not ensure that staff are trained. Staff did not keep facility from being in disrepair.

Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 09:56 AM to conduct a follow-up complaint investigation visit at the facility today. LPA met with facility staff who contacted the Designee Hasmik 'Jasmine' Khachatryan. The Designee arrived to the facility at 10:07 AM. Entrance interview was conducted and the reason for the visit was explained. During today’s visit, the LPA conducted a physical plant tour, conducted a file review for three (3) residents and one (1) staff member, obtained copies of pertinent documentation, and conducted a medication review for three (3) residents between approximately 10:15 AM and 02:40 PM. CONTINUED ON LIC 9099C. Unsubstantiated The allegation of “Facility did not ensure that staff are trained” alleges that facility staff #1 (S1) did not complete the required medication training prior to assisting residents with administering medication. LPA reviewed S1’s employee file and observed S1 to have completed the required medication training and medication administration shadowing training on 11/19/2026. LPA observed S1 to have completed ten (10) hours of medication training which covered the required six (6) hours of initial training and four (4) hours of additional training or instruction which is required be completed within the first two weeks of employment. Additionally, S1 completed six (6) hours of hands-on shadowing training out of the required two (2) hours of training. LPA interviewed S1 who was able to appropriately identify proper medication administration procedures and instructions. S1 stated that trainings on medication administration instructions were provided at the facility by a nurse. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Facility did not ensure that staff are trained.” Therefore, the allegation is deemed Unsubstantiated at this time. This report was read to the Administrator via telephone call. Exit interview conducted and a copy of this report was provided. The allegation of “Staff made changes to the facility without notifying licensing” alleges that the facility began construction of an ADU on the property without notifying Licensing or facility residents. LPA interviewed Witness #1 (W1) and Resident #1 (R1) who both stated that the facility provided no notification to the residents of the facility that construction was going to commence on the property. LPA interviewed the Administrator who stated that they spoke with each resident of the facility separately to inform them of the proposed construction prior to construction beginning. LPA reviewed communications from the facility and observed an email that was sent to Community Care Licensing Division (CCLD) on 3/5/2026 at 11:15 AM which notified CCLD of planned construction of an ADU on the property. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff made changes to the facility without notifying licensing.” Therefore, the allegation is deemed Unsubstantiated at this time. The allegation of “Staff did not maintain a comfortable temperature for residents in care” alleges that the facility was not kept at a comfortable temperature for residents. LPA interviewed W1 who stated that during Summer the facility was kept at an unreasonably hot temperature due to the AC not being turned on by staff. LPA interviewed R1 who stated that they are often cold so they prefer for the facility to be warmer. R1 did not report concerns about the facility temperature. LPA interviewed the Administrator who stated that there are two residents at the facility that prefer a warmer temperature and W1 preferred a colder temperature. The Administrator stated that they maintained the facility between 74-75 degrees Fahrenheit as a compromise for both preferences. During the physical plant tour LPA observed the facility to be at a comfortable temperature of approximately 75 degrees Fahrenheit. Additionally, LPA observed working heat/AC at the facility. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff did not maintain a comfortable temperature for residents in care.” Therefore, the allegation is deemed Unsubstantiated at this time. CONTINUED ON LIC 9099C. The allegation of “Staff did not ensure that resident's bathroom is kept clean” alleges that facility staff did not clean a private resident bathroom for weeks. LPA interviewed W1 who stated that the private resident bathroom was not cleaned regularly due to facility staff being on their phone and not performing their duties. LPA interviewed R1 who stated the facility is always very clean and staff members are always cleaning. LPA observed the private resident bathroom of the facility during visits on 10/06/2025, 04/30/2026, and 07/09/2026. On all three (3) occasions the private resident bathroom appeared to be clean and in good repair. Additionally, on all three (3) occasions LPA observed the remainder of the facility to be clean and in good repair. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff did not ensure that resident's bathroom is kept clean.” Therefore, the allegation is deemed Unsubstantiated at this time. The allegation of “Staff did not keep facility from being in disrepair” alleges that the private resident bathroom shower was in disrepair and flooded which caused water to leak into bedroom #5. LPA interviewed W1 who stated that between August-December of 2025 the private bathroom shower water flooded from the bathroom into the bedroom. W1 stated that these issues were caused as a result of a black rubber liner being in the wrong position. LPA interviewed the Administrator who denied any issues with the shower in the private resident's bathroom. The Administrator stated that concerns were brought to their attention about the shower not working so they hired a plumber to perform an inspection of the shower however no issue was found. LPA observed the private resident bathroom of the facility during visits on 10/06/2025, 04/30/2026, and 07/09/2026. On all three (3) occasions the private resident bathroom appeared to be clean and in good repair. LPA observed the black rubber liner to be a slip resistant mat installed in the shower. LPA tested the water flow in the private resident shower and observed water to appropriately drain. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff did not keep facility from being in disrepair.” Therefore, the allegation is deemed Unsubstantiated at this time. CONTINUED ON LIC 9099C.the state’s words, verbatim · CDSS document, Jul 9, 2026 · control 29-AS-20260327153057

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 09:56 AM to conduct a case management-deficiencies visit at the facility today. LPA met with facility staff who contacted the Designee Hasmik 'Jasmine' Khachatryan. The Designee arrived to the facility at 10:07 AM. Entrance interview was conducted and the reason for the visit was explained. During today’s visit, the LPA conducted a physical plant tour, conducted a file review for three (3) residents and one (1) staff member, obtained copies of pertinent documentation, and conducted a medication review for three (3) residents between approximately 10:15 AM and 02:40 PM. During the physical plant tour LPA observed ongoing construction taking place in the back yard of the facility. LPA observed two (2) emergency exit doors attached to resident bedrooms that led to the backyard of the facility where construction was taking place. LPA observed auditory alarms installed on these doors which were not turned on and did not alert when the door was opened. LPA notified the facility staff and Designee who immediately turned on the alarms. LPA reviewed three (3) resident files and observed that one (1) resident was diagnosed with Major Neurocognitive Disorder. Additionally, LPA observed a ramp railing located at the front entrance of the home to be improperly secured. LPA notified the Designee who agreed to perform repairs to the identified railing. CONTINUED ON LIC 809C. During record review LPA observed one (1) resident who had full bed rails installed was not enrolled in hospice care. LPA informed the Designee that bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. The Designee agreed to remove the full bed rails from the identified resident’s bed. During the review of staff training records LPA observed staff training records to be missing the name of the trainer who conducted the trainings. This report was read to the Administrator via telephone call. 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, Jul 9, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(d) · Plan of correction due date: Jul 23, 2026

87705 Care of Persons with Dementia (d) The licensee shall ensure that the facility has an auditory device... to monitor exits on exterior doors and perimeter fence gates... This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as auditory alarms installed on doors leading to an active construction site on the property were not engaged which poses a potential safety risk to clients in care.the state’s words, verbatim · CDSS document, Jul 9, 2026

Plan of correction: Designee agreed to submit a statement of understanding confirming that the auditory alarms will stay on and active while construction is on going and while the facility retains any residents with major neurocognitive disorder/dementia. Designee agreed to submit the statement to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87307(d)(4) · Plan of correction due date: Jul 23, 2026

87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (4) ...unless equipped with sturdy hand railings and unless well-lighted. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as an entryway hand railing was not installed securely which poses a potential safety risk to clients in care.the state’s words, verbatim · CDSS document, Jul 9, 2026

Plan of correction: Designee agreed to have repairs to the railing performed to ensure that the railing is installed securely. Designee agreed to submit proof of the repairs to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Jul 23, 2026

87608 Postural Supports (a) ...(5) ... (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care... This requirement is not met as evidenced by: Based on observation and record review the licensee did not comply with the section cited above as a resident who was not receiving hospice care had full bed rails installed which poses a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jul 9, 2026

Plan of correction: Designee agreed to remove the full bed rails from the identified resident's bed and to send proof of the removed full bed rails to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(c)(2)(A) · Plan of correction due date: Jul 23, 2026

87412 Personnel Records (c) Licensees shall maintain.... (2) Documentation of staff training shall include: (A) Trainer’s full name; This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as staff trainings reviewed were missing the name of the trainer which poses a potential health, safety, or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jul 9, 2026

Plan of correction: Designee agreed to add the staff trainers name to all completed staff trainings and to send proof of the updated documents 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 10:30 AM. LPA met with Administrator Lilit Tonoyan. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:35 AM, the LPA, along with the 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; four (4) are single occupancy resident rooms and one (1) is a dual occupancy resident room. LPA and the 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 facility exits and were functioning at the time of inspection. Bedrooms #3 and #5 contain direct exits to the outdoors of the facility. LPA observed Resident #1 (R1)’s bedroom to contain two unsecured inhalers. LPA reviewed R1’s file and observed that R1 was determined by their physician to not be able to store their own medications. LPA informed the Administrator who immediately secured the two inhalers. Continued on LIC 809C. BATHROOMS: There are three (3) bathrooms at the facility. Two (2) bathrooms are designated as shared/common 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. Grab bars were observed in resident showers and near resident toilets, all were properly secured. The water temperature was measured between 114.6 and 118.4 degrees Fahrenheit, which is in compliance with regulation. KITCHEN: 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 two (2) secured drawers to contain knives and other sharp objects. LPA observed a locked under-sink cabinet to contain cleaning supplies. LPA observed a wall mounted fire extinguisher to be fully charged and last serviced on 09/04/2025. COMMON AREAS: This includes the living room, dining area, Administrator’s office, 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, and activities for resident use. Additionally, the living room was observed to contain an appropriately screened fireplace. The dining area 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 dining area wall. The Administrator’s office was observed to contain locked cabinets which contained resident medications, facility files, personal grooming supplies, and additional care supplies. The hallway was observed to contain the facility’s washer and dryer and a storage cabinet that contained bleach bottles. At 10:44 AM LPA observed this storage cabinet to be unlocked at the time of the inspection. LPA notified the Administrator of the accessible chemicals. The Administrator had the chemicals secured at the time of the inspection. Combination fire and carbon monoxide alarms and fire doors were tested at 10:52 AM and functioned properly at the time of inspection. LPA observed cameras throughout the common areas of the facility. The Administrator confirmed that the cameras do not record audio. Continued on LIC 809C. OUTDOOR SPACE: The facility has one (1) emergency exit gate located in the front yard of the facility. All fences/railings at the facility were secured properly. LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed the back yard to contain two (2) properly secured sheds that contained extra care supplies and gardening equipment. LPA observed a properly secured garage located in the yard of the facility. LPA inspected the garage and was informed by the Administrator that Individual #1 (I1) was residing in the garage. LPA observed the garage to contain furniture consistent with an individual residing in the building including but not limited to: a sink, cabinets, a couch, Etc. LPA reviewed the facility’s approved fire clearance and observed a note which stated “Garage to be used as a garage only.” LPA informed the Administrator who stated that they have obtained a sketch of the building but have not completed the application to convert the building into an ADU. LPA informed the Administrator that having an individual residing in the garage is a direct violation of their fire clearance. LPA explained that fire clearance violations are a zero-tolerance violation and an immediate civil penalty in the amount of $500 will be assessed on today’s date (10/06/2025). LPA informed Administrator that failure to adhere to the requirements of their fire clearance may result in the assessment of additional civil penalties. RECORD REVIEW: Record review began at 11:00 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. Three (3) staff files were reviewed. All staff files contained the required documentation and trainings. Three (3) resident files were reviewed. All resident files contained all required documentation and signatures. During record review LPA did not observe I1 to be associated to the facility. LPA informed the Administrator who stated that I1 is finger print cleared but works for another facility. The Administrator stated that I1 has resided at the facility since July of 2025. LPA informed the Administrator that any individual, prior to working, residing or volunteering in a licensed facility, shall be finger print cleared and associated to the facility. LPA explained that since I1 had resided at the facility since July and was not associated to the facility an additional civil penalty in the amount of $3000 will be assessed on today’s date (10/06/2025). LPA informed the Administrator that this is their second violation of CCR 87355(e)(3) within a 12 month period. LPA informed Administrator that failure to associate I1 to the facility may result in the assessment of additional civil penalties. Continued on LIC 809C. MEDICATION REVIEW: Medication review began at 01:07 PM. Medications are stored centrally and securely in a cabinet in the Administrator’s office. Medications for two (2) residents were observed. All medications observed were documented appropriately on their centrally stored medication and destruction 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 they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly. The facility’s last emergency disaster drill was conducted on 09/02/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed one (1) staff and one (1) resident. The resident interviewed stated that the staff treat them well and are attentive to their needs. The resident interviewed had no 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. 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 deficiencies and civil penalties 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, Oct 6, 2025

Allegation investigated: Insufficient Staffing.

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation visit at the facility at 09:56 AM. LPA met with facility Administrator Lilit Tonoyan. The reason for the visit was explained and entrance interview was conducted. During today’s visit LPA conducted a physical plant tour, reviewed five (5) employee files, obtained copies of pertinent documentation, and interviewed the Administrator, two (2) staff, one (1) witness, and two (2) residents between 10:06 AM and 12:50 PM. Continued on LIC-9099C Unsubstantiated The allegation of “Insufficient Staffing.” alleges that the facility did not employ a sufficient number of staff to care for the facility residents. LPA Byrne observed the facility to currently have two (2) residents at the time of the inspection. LPA interviewed two (2) of two (2) residents. LPA interviewed resident #1 (R1) who confirmed that facility staff are present at all times. R1 stated that the facility Administrator is present throughout the week during the day. Both residents stated that facility staff assist them in caring for their needs. LPA interviewed one (1) staff member, staff #1 (S1). S1 confirmed that they work as a caregiver at the facility and stated that they just began working at the facility today (04/30/2025). S1 described their schedule as Wednesday – Monday from 7 AM to 6:30-7 PM. S1 had no concerns with insufficient staffing at the facility. LPA Byrne interviewed the facility Administrator. The Administrator confirmed that S1’s works as a caregiver and is scheduled Wednesday - Monday 7 AM – 7 PM, with S1’s day off being Tuesdays. The Administrator stated that staff #2 (S2) works as the awake night staff Monday – Sunday 7 PM – 7 AM. The Administrator informed LPA that a former caregiver was let go on 04/21/2025. The Administrator stated that staff #3 (S3) was hired to cover the vacant position in the meantime. LPA interviewed S3 who stated that they only worked for the facility from 04/21/2025-04/29/2025. S3 did not express concerns with adequate staffing at the facility. LPA reviewed the facility’s LIC 500 Personnel Roster. LPA observed this roster to contain the following work schedules: Administrator, Monday – Friday 08:00 AM – 04:00 PM, Saturday – Sunday 07:00 AM – 07:00 PM. S2 Monday – Sunday 07:00 PM – 07:00 AM. S1 Wednesday – Monday 07:00 AM – 07:00 PM. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Insufficient Staffing.” Therefore, the allegation is deemed Unsubstantiated at this time. A copy of the report was printed and exit interview was conducted.the state’s words, verbatim · CDSS document, Apr 30, 2025 · control 29-AS-20250422081655

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced case management - deficiencies visit at the facility at 09:56 AM. LPA met with facility Administrator Lilit Tonoyan. The reason for the visit was explained and entrance interview was conducted. During today’s visit LPA conducted a physical plant tour, reviewed five (5) employee files, obtained copies of pertinent documentation, and interviewed the Administrator, two (2) staff, one (1) witness, and two (2) residents between 10:06 AM and 12:50 PM. LPA Byrne interviewed staff #1 (S1) who stated that today (04/30/2025) was their first day working at the facility. S1 stated that they have been living at the facility for “a couple of days”. S1 confirmed that they were not working with the residents prior to today (04/30/2025). LPA interviewed the facility Administrator who confirmed that today (04/30/2025) is S1’s first day working at the facility. The Administrator stated that S1 has been living at the facility since Monday (04/28/2025). LPA reviewed the list of employees associated and cleared to work at the facility. LPA did not observe S1’s name on the list. LPA asked the Administrator why S1 was not associated to the facility. The Administrator informed LPA that S1 had worked for licensed facilities previously and is background cleared. LPA informed the Administrator that a transfer of S1’s criminal record clearance and an association to the facility must be completed prior to S1 working or residing at the facility. LPA informed the Administrator that failure to request a transfer of the criminal record clearance for S1 will result in an immediate civil penalty of $100 per day for a total of $300. This total was calculated as $100/day * 3 days * 1 employee = $300 total and began from the date S1 began residing at the facility until the date of today’s inspection (04/28/2025-04/30/2025). The Administrator stated that they would request a criminal record transfer for S1 to be associated to the facility. Continued on LIC 809C. The following deficiency was cited, and a civil penalty was assessed (Refer to LIC 809D). Exit interview conducted, a copy of the report, civil penalty, and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 30, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: May 1, 2025

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review...prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance... This requirement is not met as evidenced by: Based on file review and interview the licensee did not comply with the section cited above as one employee did not have a transfer of their criminal record clearance which poses an immediate health, safety, or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Apr 30, 2025

Plan of correction: Licensee will submit proof of association of S1 to the facility no later than POC due date.

Allegation investigated: Staff did not meet resident's medical needs. Staff did not administer resident's medications as prescribed.

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation visit at the facility at 09:45 AM. LPA met with facility staff who contacted the facility Administrator Lilit Tonoyan. The Administrator arrived to the facility at approximately 10:15 AM the reason for the visit was explained and entrance interview was conducted. During today’s visit LPA conducted a physical plant tour, reviewed three (3) resident files, three (3) staff files, conducted a medication audit for two (2) residents, and interviewed the Administrator, the Licensee, one (1) staff and two (2) residents between 10:00 AM and 02:30 PM. Continued on LIC-9099C Substantiated The allegation of “Staff did not meet resident's medical needs.” alleges that the facility did not assist resident #1 (R1) in conducting a medical appointment with their physician. LPA interviewed R1 who revealed that recently they were supposed to have an in-person medical appointment with their physician earlier in the month. R1 revealed that they were unable to attend the appointment in-person due to issues in arranging the transportation. R1 stated that the visit was conducted via telephone call instead. LPA interviewed the Administrator who stated that R1’s doctor is in another city and family of R1 had not arranged transport to the medical appointment. Additionally, the Administrator revealed that during R1’s stay at the facility R1 has missed a total of two (2) appointments due to issues with arranging transportation. LPA reviewed R1’s admission agreement to the facility. LPA observed the following entry in the admission agreement, “Transportation-Responsible persons may and are encouraged to provide basic transportation. Facility may provide resident with transportation when responsible person or an alternative arrangement is unavailable, to be billed at a minimum of $30.00 per hour or any portion of an hour to cover driver and/or caregiver escort.” LPA informed that Administrator that per the signed admission agreement the facility agreed to provide transportation to medical appointments for R1. The Administrator expressed understanding and confirmed that they would assist residents in arranging transportation to future medical appointments. Based on the information obtained during interviews and file review there is sufficient evidence to support the allegation of “Staff did not meet resident's medical needs.” Therefore, the allegation is deemed Substantiated at this time. The allegation of “Staff did not administer resident's medications as prescribed.” alleges that the facility did not administer R1’s medications as prescribed. LPA interviewed R1 who stated that they believe the facility is not administering all of their required medications. LPA reviewed R1’s hospital paperwork dated 04/07/2025. LPA observed R1’s hospital paperwork to contain prescriptions for seventeen (17) medications and one (1) medical device. LPA conducted a medication review for R1. R1’s centrally stored medication and destruction record sheet was observed to contain six (6) medications. LPA asked the Administrator where the rest of R1’s medications were. The Administrator stated that the family of R1 has not dropped off the remaining medications. The Administrator stated that the facility has been waiting for the family to obtain the medications and has not made an effort to get R1’s prescribed medications yet. The interview with the facility’s other resident did not reveal concerns with their medication administration. Based on the information obtained during interviews and file review there is sufficient evidence to support the allegation of “Staff did not administer resident's medications as prescribed.” Therefore, the allegation is deemed Substantiated at this time. Continued on LIC 9099C. The following deficiencies were cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.the state’s words, verbatim · CDSS document, Apr 21, 2025 · control 29-AS-20250418084125

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(2) · Plan of correction due date: May 5, 2025

87465 Incidental Medical and Dental Care (a) ... provide for assistance in obtaining such care... (2) ...This includes transportation... the licensee shall do so directly or make arrangements for this service. This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above as R1 has not been to two in-person medical appointments during their care at the facility which poses a potential health risk to clients in care.the state’s words, verbatim · CDSS document, Apr 21, 2025

Plan of correction: Licensee will submit a statement of understanding confirming that they will assist residents with their transportation needs to medical appointments. Licensee will submit their plan on how they will obtain transportation for R1 no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 5, 2025

87465 Incidental Medical and Dental Care (a) ...provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above as R1 has not been receiving 11 medications that were perscribed by their physician which poses a potential health risk to clients in care.the state’s words, verbatim · CDSS document, Apr 21, 2025

Plan of correction: Licensee will submit proof that the 11 identified medications have arrived at the facility and are being given as prescribed no later than POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 09:45 AM. LPA met with facility staff who contacted the facility Administrator Lilit Tonoyan. The Administrator arrived to the facility at approximately 10:15 AM the reason for the visit was explained and entrance interview was conducted. During today’s visit LPA conducted a physical plant tour, reviewed three (3) resident files, three (3) staff files, conducted a medication audit for two (2) residents, and interviewed the Administrator, the Licensee, one (1) staff and two (2) residents between 10:00 AM and 02:30 PM. Interviews with the facility Administrator and resident #1 (R1) revealed that the facility did not have a dedicated internet access device for resident use. Interviews with R1 revealed that in April R1 was unable to attend an in-person appointment with their primary care physician. R1’s physician requested that the appointment be done via Zoom or Face-Time call. R1 revealed that the facility did not provide a device that was capable of video conferencing, so the appointment was conducted over the telephone instead. In the interview with the Administrator they stated that the internet access device for the facility is the Administrator’s personal cell phone. LPA informed the Administrator that the device must always be present at the facility and must be dedicated for resident use. The Administrator agreed to obtain an internet access device to be left at the facility for resident use. Interviews with R1, Witness #1 (W1), and Staff #1 (S1) revealed that the facility has been crushing medications into R1's food. W1 stated that the facility informed them that they had crushed medications into R1's food. An interview with S1 confirmed that the facility has crushed medications and disguised it into R1's foods. The facility Administrator admitted that staff crush medications into R1's foods. The following deficiency was cited (Refer to LIC 809D). Exit interview conducted, appeal rights and a copy of the report were provided.the state’s words, verbatim · CDSS document, Apr 21, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.319(a) · Plan of correction due date: May 5, 2025

§1569.319 (a) A licensee...shall provide at least one internet access device...that can support ... videoconferencing technology, including microphone and camera functions, and is dedicated for resident use. This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above as the facility did not have a resident dedicated internet access device which poses a potential health or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Apr 21, 2025

Plan of correction: Licensee will submit proof of an appropriate internet access device to stay at the facility and be for resident use. Licensee will submit proof no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(a)(5)(D) · Plan of correction due date: May 5, 2025

87465Incidental Medical and Dental care (a) ...compliance with the following: (5) ... shall be limited to the following: (D Assistance with self-administration does not include...hiding or camouflaging medications in other substances... This requirement is not met as evidenced by: Based on interview the licensee did not comply with the section cited above as the facility has been crushing R1's medications into their food which poses a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Apr 21, 2025

Plan of correction: Licensee will submit a statement of understanding confirming that they will not disguise or crush medications of residents. Licensee will submit this statement to CCLD no later than POC due date.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Trevor Byrne conducted a pre-licensing visit to the above noted facility at 08:46 AM. The LPA met with applicant, Avag Petrosyan and administrator Lilit Tonoyan. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver has been requested. The facility is one story. At 08:49 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for five (5) non-ambulatory residents; and, one (1) of bedridden resident. The facility has four (4) private resident bedrooms, Rooms # 1, 2, 3, and 5 and one (1) shared room, Room # 4. Bedroom # 3 has a direct exit to the outside and is the bedridden approved room. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linens; which includes, a mattress pad, top and bottom linens, pillowcases, blanket and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are no staff rooms at the facility, awake night staff are required. All rooms were free of odors. LPA observed the window screens in bedrooms # 2, 3, and 5 to be ripped. There are three (3) bathrooms in the facility all are designated as resident bathrooms. All resident bathrooms have a shower with non-skid materials. All toilets and showers have grab bars and all were properly secured. The hot water temperature was measured as follows: bathroom #1 = 116.6 F, bathroom #2 = 118.6 F, bathroom #3 = 117.4 F, which falls within the allowable range of 105 F to 120 F. Resident and staff records are stored in cabinet which is currently located in the staff office. Medications are centrally stored in a locked cabinet in the staff office. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in a cabinet in the staff office. Continued on 809 C. Kitchen knives and other sharp objects are stored in a locked drawer in the kitchen. Stove burners are rendered inaccessible to the residents by removing them when not in use. The supply of dishes, utensils, pots, pans, and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0 F) and the refrigerator was maintained at thirty-five degrees Fahrenheit (35 F). The supply of nonperishable food is adequate. There are no pesticides, poisons, or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in locked cabinets located under the kitchen sink, in a secured cabinet in the hallway, and in a secured cabinet in the staff office. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment, and activity supplies in the living room. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in all hallways and passageways to nonprivate bathrooms. Inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight were equipped with sturdy hand railings and were well-lighted. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. There is an electric fireplace in the living room. It is appropriately screened and there are no tools. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility smoke alarm system is hard wired. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. Both facility fire doors were observed to properly close at the time of the test. There is one (1) fire extinguisher the house located on the kitchen wall. It is fully charged and does not exceed the expiration date. Continued on 809 C. The laundry area is located in the hallway of the facility. The supply of extra bed and bath linens is adequate. Personal hygiene items shampoos, soaps were adequate and are stored in the resident bathrooms. Extra incontinence supplies are stored in a cabinet located in the staff office. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted in each resident room and in the hallways. The emergency telephone numbers are posted on the wall in the dining area. Other required postings are posted on the common room walls. The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the front of the house with tables and chairs where residents can sit. The entire property is fenced. The gate to the driveway is moved automatically. There is a gate at the front entrance of the property that does not self latch. There is a locked storage shed in the back yard that contains lawn care tools and maintenance supplies. There are not any bodies of water on the premises at the present time. The garage is not accessible from the house; the doors were locked. COMP III orientation was conducted with the applicant. Applicant expressed understanding of the material covered. The following items must be corrected prior to licensure. Submit proof of corrections, along with a copy of this report, to LPA Byrne so that your application may be completed. 87303(c) - All window screens shall be clean and maintained in good repair. 87705(h) - Outdoor facility space used for resident recreation and leisure shall be completely enclosed by a fence with self-closing latches and gates, or walls, to protect the safety of residents. This report will be sent to the Centralized Application Bureau (CAB) once all corrections are received. You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.the state’s words, verbatim · CDSS document, Oct 16, 2024

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: INTL Capacity: 6 Census : 0 Method: Telephone call with CAB COMP II Participants: Avag Petrosyan (Licensee), Lilit Tonoyan (Administrator), & Tammy Edwards,(Analyst). Licensee & administrator participated in COMP II via Telephone call with CAB Analyst. Identification of licensee/administrator was verified by confirming driver’s license numbers. During COMP II, licensee/administrator confirmed the understanding of Title 22. Component II was successfully completed. Licensee/administrator were advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed licensee's/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, Sep 25, 2024