Rossmoyne Hills

Allegation investigated: Unlicensed care

At approximately 12:15 p.m. on 03/11/26 Licensing Program Analysts (LPAs) Antonia Alvizar-Ettima and Nicholas Reed conducted an unannounced complaint visit. LPAs met with the property owner's wife and disclosed the reason for the visit. On 11/18/25, Licensing Program Analysts (LPA) Antonia Alvizar-Ettima and Nicholas Reed along with Adult Protective Services (APS) Social Worker (SW) Sona Shahumyan conducted an unannounced complaint visit. LPA Reed called an associate of the homeowner at 10:30 a.m. today and was notified that nobody was home and no clients were in care. Between 10:45 a.m. and 11:45 a.m., LPAs surveyed the outside of the building, interviewed four (04) neighbors, and contacted the Glendale Police Department (GPD). On 02/11/26 Licensing Program Analysts (LPAs) Antonia Alvizar-Ettima and Nicholas Reed conducted an unannounced complaint visit. LPAs were joined by Adult Protective Services (APS) agent Arturo Torres. Cont. on LIC 9099-C Substantiated Cont. from LIC 9099 LPAs and APS met with the property owner’s daughter and disclosed the reason for the visit. LPA Reed entered the building at approximately 11:30 a.m. and toured the inside. No residents were observed inside of the facility. Regarding the allegation “Unlicensed care”, it was alleged an individual requiring care and supervision was living in the building. It was further alleged that resident #1 (R1) residing at the facility require assistance with all Activities of Daily Living. (ADL) during a period the facility was unlicensed. Evidence obtained showed that R1 lived at the facility between 09/08/2025 to 09/30/2025. During the course of the investigation, the LPA’s determined that the license for the facility was closed at effective 07/30/2025. Documentation obtained and reviewed during the investigation indicates that the facility continued operating after the licensee closure. Resident #1 (R1), who required care and supervision to retain activities of daily living, was residing at this location within the month of September 2025, after the facility license was forfeited and the file was closed. Operating a residential care facility for the elderly without a valid license is prohibited by law. Based on the interviews, and pertinent information received from the credible witnesses, there is sufficient information to verify that the facility continued operating and providing care to R1 after the facility was unlicensed. Therefore, the allegation is deemed SUBSTANTIATED at this time. A deficiency is issued on the corresponding LIC 9099-D page. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Mar 11, 2026 · control 31-AS-20251110113211

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.10 · Plan of correction due date: Mar 11, 2026

1569.10 RCFE; license or permit; necessity - No person, firm, partnership, association, or corporation...shall operate ... a residential facility for the elderly in this state without a current valid license or current valid special permit therefor, as provided in this chapter. This requirement is not met as evidenced by Based on interviews the licensee did not comply with the section cited above and provided care and supervision to 1 resident after the facility license was closed which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 11, 2026

Plan of correction: The deficiency has been cleared at this time due to the facilty having no staff or residents.

Allegation investigated: Neglect in care and supervision lead to resident's death

At approximately 10:45 a.m. on 09/26/25, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced Licensing Visit to deliver findings for the above noted allegation. LPA was unable to meet with the lieensee or staff to disclose the reason for the visit. It was alleged that on 02/27/25 at approximately 10:58pm, as Glendale Police Department (GPD) officers were present at the facility for a separate incident, one of the officers observed a resident #1 (R1) slumped over in their chair and appeared to be unresponsive. An officer checked R1’s pulse, realized that R1 had no pulse, and commenced with life saving measures. Glendale Fire Department was called by another officer. R1 was pronounced dead at the scene by Glendale Fire Department staff. The investigation was initiated by the LPA Nicholas Reed on 02/28/2025. The allegation was referred to CCLD investigation Bureau and assigned to Senior Investigator (SI) Olivia Spindola. Substantiated During the investigation on 02/28/2025, LPA Nicholas Reed toured the facility at 10:15 a.m., interviewed residents and staff between 10:30 a.m. and 12:45 p.m., and conducted a record review at 1:00 p.m. On 03/14/2025, SI Spindola reviewed records previously requested and obtained from Glendale Fire Department and GPD. In addition, SI Spindola reviewed medical records from the Kaiser Permanente Antelope Valley and Coroners Examiners Report. On 04/08/25, SI Spindola reviewed camera footage received from the GPD. Interviews revealed that R1 was admitted to the facility over one (01) week prior, approximately on or after 1/14/25 with no records. The Administrator claimed she conducted a pre-assessment of R1, however, she could not produce any documentation. Staff #1 (S1) present at the facility revealed that they had no knowledge of R1’s health conditions, medication assistance and need and service plan. S1 stated that on the night of 02/27/25, Staff #2 (S2) gave R1 some yogurt about 30 minutes prior to the arrival of the police and R1 was responsive. R1 had no assigned bedroom and was staying in the living room. Glendale Police Records revealed that S1 informed the police that R1 was alive 30 minutes prior and was eating “yogurt and drinking water due to not being able to eat solid food.” S1, S2 and the Administrator informed GPD officers that they had no medical information for R1 and had no knowledge of R1’s medical issues. A review of Coroners Examiners Report and Kaiser records revealed that R1 had multiple health conditions that required medical attention that was not provided at the facility. Kaiser records revealed that R1 was admitted to the hospital on 01/06/2025 and was treated for several health conditions that required immediate medical attention. As of 01/14/2025, R1 was prescribed medication to control R1’s blood pressure, heart and kidney disease, and preventative heart medication. Review of police body camera footage on 02/27/25 at 10:54pm revealed R1 was seen slumping over a wheelchair by a living room window next to a fireplace. No staff were observed around R1. Based on inspection of the facility, review of medical records, and interviews, the facility admitted of R1 without any medical records or knowledge of their existing diagnoses, history of R1’s health conditions, or a list of R1’s medication, R1 was neglected and did not receive proper care and supervision which led to R1’s death. R1 passed away on 02/27/25. Therefore, the allegation of neglect in care and supervision lead to a resident’s death is SUBSTANTIATED. A $500 immediate civil penalty is assessed today for a violation resulting in injury and/or death to R1. The licensee was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f). Appeal rights and copy of report provided.the state’s words, verbatim · CDSS document, Sep 26, 2025 · control 31-AS-20250228100858

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.312(e) · Plan of correction due date: Sep 27, 2025

§1569.312 Basic services requirements Every facility... shall provide...: (e) Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being. This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above by not providing appropriate care and supervision to Resident #1 (R1) which posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 26, 2025

Plan of correction: The facility is closed, and the Licensee is excluded from all Departmental involvement. No plan of correction possible at this time. Deficiency is therefore cleared.

Type of visit: Case Management - Other

At approximately 10:30 a.m. on 08/05/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. Today’s case management visit was conducted to ensure no clients were residing at the facility or receiving care and supervision. LPA was unable to gain entry to the facility due to no staff being present. LPA attempted to contact the administrator and licensee via telephone at 10:45 a.m. and 10:50 a.m. and received no reply. LPA looked through the fornt windows and side gate and observed no signs of inhabitants. No immediate health or safety hazards were observed during today’s visit. Copy of report provided emailed to the facility email address. No staff present to sign today's report.the state’s words, verbatim · CDSS document, Aug 5, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Angela Panushkina, along with Licensing Program Manager (LPM) Nichelle Gillyard, and Regional Manager (RM) Angela Whittaker, conducted an unannounced Case Management Visit at this facility. RM, LPM, and LPA met with Elba Khachatryan, daughter of the licensee, and Albert Khachatryan - Licensee and explained the reason for the visit. The purpose of the visit is to issue two Temporary Suspension Orders (TSO). The TSO's effective date is the close of business hour today. The TSOs are for Rossmoyne Hills and Silver Light Care located at 8201 Vantage Ave North Hollywood, CA 91605 (#195850239). Elba Khachatryan was also notified that there is a Temporary Manager at the Silver Light Care facility effective today. During the visit, two (2) residents were relocated from this location to another licensed facility and one (1) moved in with their family/friends. During today’s visit, “Order to Individual of Immediate Exclusion” was hand delivered to Albert Khachatryan, for this facility for Albert Khachatryan, Edgar Khachatryan and Knarik Panosyan. One "Order to Individual of Immediate Exclusion: was hand delivered to Knarik Panosyan for Silver Light Care (#195850239). It was determined by the Department that a complaint of conduct inimical was substantiated against Albert Khachatryan, Edgar Khachatryan and Knarik Panosyan, thus, necessitating the Order for Immediate Exclusion from both facilities. The Order regarding Individual Exclusion indicates that Albert Khachatryan, Edgar Khachatryan and Knarik Panosyan are not allowed to have contact with clients or to be present at any facility licensed by the California Department of Social Services. Moreover, at the time of this visit, another licensed facility, Silver Light Care (#195850239) had been also served a TSO with the Temporary Manager (TM) in place. Appeal rights explained. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Aug 1, 2025

Type of visit: Case Management - Health Checks

At 2:00 p.m. on 07/31/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with staff and disclosed the reason for the visit. Today’s case management visit was conducted to verify the health and safety of residents in care. LPA toured the facility at 2:05 p.m., interviewed the administrator, staff, and residents between 2:10 p.m. and 2:45 p.m., and conducted a records review of resident files at 2:25 p.m. No immediate health or safety concerns were observed during today’s visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 31, 2025

Allegation investigated: Staff physically assaulted a resident Staff stole resident's property

At 1:45 p.m. on 07/30/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the licensee and disclosed the reason for the visit. To investigate the allegations above, LPA Reed conducted an initial visit with Licensing Program Manager (LPM) Naira Margaryan at approximately 10:20 a.m. on 03/04/25. LPA and LPM were unable to gain entry to the facility after several attempts. Telephonic interview with administrator Armine Avetisyan at 10:48 a.m. on 03/04/25 confirmed no staff or residents were present, and she was unable to attend the visit. LPA Reed and LPM Margaryan noted her response. The case was referred to the Investigations Branch (IB) for further investigation and accepted by Investigator Olivia Spindola on 03/04/25. Investigator Spindola made multiple attempts to interview facility staff on 04/08/25, 04/11/25, 05/07/25, 05/15/25, and 06/06/25. The licensee, Staff #1 (S1), and Staff #2 (S2) never responded to the investigator’s requests for interviews. Substantiated Spindola also obtained Glendale Police Department (GPD) reports on 03/17/25 and GPD body camera footage on 04/02/25. LPA received and reviewed Investigator Spindola’s final report at 8:30 a.m. on 07/28/25. Today, LPA toured the facility at 1:50 p.m. Regarding the allegation "Staff physically assaulted a resident" it was alleged S1 dragged Resident #1 (R1) to their room and hit them in the face with a closed fist about five (05) times. Despite multiple attempts, S1 and the licensee were not available for interview. Spindola’s interview with Resident #2 (R2) at 1:00 pm on 05/27/25 revealed they were also hit by S1 on 02/27/25 for moving too slowly. Spindola’s interview with Resident #3 (R3) at 12:30 p.m. on 05/29/25 revealed they witnessed the licensee hit another resident, Resident #4 (R4), and caused them to fall backwards around February 2025. Review of a GPD report revealed Officer Gallegos also interviewed R3 around 2:30 p.m. on 02/28/25. R3 told Officer Gallegos that they witnessed staff take R1 into their room and walk out without R1. LPA Reed telephonically interviewed a former resident, Resident #5 (R5), at 12:35 p.m. on 02/28/25 as part of investigation # 31-AS-20250228100858 who revealed they were also hit multiple times by S1 and the licensee. Based on interviews from this investigation and a previous investigation, staff physically assaulted residents in care. Therefore, the allegation is deemed SUBSTANTIATED at this time. A deficiency is issued on the corresponding LIC 9099-D page. A $500 immediate civil penalty is assessed today for the violation of physical abuse of persons in care. The licensee/administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f). Regarding the allegation "Staff stole resident's property" it was alleged staff took R1’s cell phone and wallet. R1’s wallet and black flip phone were missing after S1 dragged them to their room in February 2025. Residents interviewed provided no pertinent information regarding the whereabouts of R1’s belongings. LPAs Reed and Rahimi conducted a case management visit on 02/28/25 and were later joined by Officer Gallegos of the GPD. LPAs did not observe R1’s belongings at the time of the visit. Review of a GPD police report indicated that later that day, around 3:15 p.m. after LPAs left, Agent Torres and Officer Staap of the GPD joined Officer Gallegos at the facility. According to the report, the licensee told officer Gallegos he did not know where R1’s phone and wallet were. Later, officers saw the licensee enter the dining area holding a black flip phone in his hand. Officer Staap questioned the licensee about the phone, and the licensee became upset and threw the phone in the kitchen. Officer Staap walked to pick up the phone, and the licensee followed the officer. Officer Gallegos instructed the licensee to stop and put his hands up, but the licensee did not follow instructions and pushed against the officer and swatted the officer’s hands away. The licensee was then arrested for battery against an officer. Based on record review and GPD observations, staff stole R1’s phone. Therefore, the allegation is deemed SUBSTANTIATED at this time. A deficiency is issued on the corresponding LIC 9099-D page. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 30, 2025 · control 31-AS-20250303144817

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.269(a)(10) · Plan of correction due date: Jul 31, 2025

§1569.269 Enumerated rights; severability (a) Residents... shall have all of the following rights: (10) To be free from neglect... punishment... intimidation, and... physical... abuse. This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above by not ensuring at least three (03) residents remained free from abuse from staff which posed an immediate risk to the Health, Safety, or Personal Rights of persons in care.the state’s words, verbatim · CDSS document, Jul 30, 2025

Plan of correction: Licensee to conduct and in-service training on the cited section with all staff and submit proof of training by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.152(a) · Plan of correction due date: Jul 31, 2025

§1569.152 Safeguard of resident property... (a) A... facility...which fails to ... safeguard resident property shall reimburse a resident for or replace stolen or lost resident property at its then current value. This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above by not safeguarding the belingings of Resident #1 (R1) which posed an immediate risk to the Health, Safety, or Personal Rights of persons in care.the state’s words, verbatim · CDSS document, Jul 30, 2025

Plan of correction: Licensee to conduct and in-service training on the cited section with all staff and submit proof of training by the POC due date.

Allegation investigated: Resident's medical records were not available at the facility

At 1:45 p.m. on 07/30/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the licensee and disclosed the reason for the visit. To investigate the allegations above, LPA Reed conducted an initial visit with LPA Huma Rahimi on 02/28/25 and toured the facility at 10:15 a.m., interviewed residents and staff between 10:30 a.m. and 12:45 p.m., and conducted a record review at 1:00 p.m. of pertinent records, including but not limited to an admission agreement, medical assessment, and a care plan. The case was referred to the Investigations Branch (IB) on 02/28/25. The case was accepted by Investigator Olivia Spindola and Special Investigator Assistant (SIA) Amina Luckett on 03/04/25. Between 03/17/25 and 03/21/25, Luckett obtained a Glendale Fire Department Report, death and incident reports from the Glendale Polce Department Report, and medical records of Resident #1 (R1). From 04/02/25 to 06/12/25 Spindola interviewed residents and staff and obtained police bodycam footage and R1’s death certificate and autopsy report. LPA received and reviewed Investigator Spindola’s final report at 8:30 a.m. on 07/28/25. Substantiated Today, LPA toured the facility at 1:55 p.m. Regarding the allegation "Resident's medical records were not available at the facility" it was alleged the facility did not maintain the records for R1. During an interview around 12:30 a.m. on 02/28/25 with County of Los Angeles Medical Examiner (CLAME) Investigator Jennifer Mantie, Administrator Armine Avetisyan stated that R1 arrived to the facility without any records. Avetisyan also confirmed this to LPA Reed during a telephonic interview at approximately 11:45 a.m. on 02/28/25. Avetisyan noted that she assessed R1 at their home prior to R1’s admission, but Avetisyan did not know where the assessment form was. When LPAs Reed and Rahimi requested R1’s records from Licensee Albert Khatchatryan, he provided records for four (04) of the six (06) residents in the facility. Khatchatryan did not provide records for R1. Based on observations, interviews, and record review, R1’s records were not available at the facility. Therefore, the allegation is deemed SUBSTANTIATED at this time. A deficiency is issued on the corresponding LIC 9099-D page. No immediate health or safety concerns were observed during today’s visit. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 30, 2025 · control 31-AS-20250228100858

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Aug 11, 2025

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility. This requirement was not met as evidenced by: Based on interviews, record review, and observations, the licensee did not comply with the section cited above by not maintaining compete records for at least three (03) residents whic posed a potential risk to the Health, Safety, or Personal Rights of persons in care.the state’s words, verbatim · CDSS document, Jul 30, 2025

Plan of correction: Licensee to conduct and in-service training on the cited section with all staff and submit proof of training by the POC due date.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

At approximately 1:00 p.m. on 07/23/25, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with staff and disclosed the reason for the visit. Today’s case management visit was conducted due ensure there were no residents in care and no resident belongings still in the facility. LPA toured the facility today at approximately 1:10 p.m. and confirmed that no residents or resident belongings were in the facility. No immediate health or safety concerns were observed during today’s visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 23, 2025

Type of visit: Required - 1 Year

At 9:45a.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection to the facility. LPA was unable to gain entry to the facility after several attempts. LPA called the administrator at 10:05 a.m. and disclosed the reason for the visit. Administrator stated there were no staff or residents at the facility. Administrator arrived at approximately 10:35a.m. and granted LPA access to the facility. At 11:00a.m., Administrator and LPA conducted physical plant tour inside and out. During the tour, LPA observed that the facility is a home located in a residential community. The front main door is the only entrance being utilized at the facility; it has a total of (04) bedrooms and two and half 2 ½ bathrooms. Three (03) shared bedrooms and one (01) and half (1/2) bathrooms are designated for residents. One (01) bedroom and one (01) bathroom are designated for live – in staff. Fire/Earthquake drill was last conducted on 01/02/2025. Required posting observed displayed in the facility office area (complaint hot line poster, personal rights, etc). Temperature of facility wall thermostat is observed and set to 76 Fahrenheit. The fire alarm/CO system was tested and observed to be working. No obstructions and or tripping hazards throughout the facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Common Areas: These included the living room and dining area for residents. The common areas were properly furnished. Furniture in common area were observed to be in good repair. Fireplace in the living room was observed to be covered with protective metal gate and glass doors. Residents dining table fits six (06) residents. (Continued to LIC 809-C) (Continued from LIC 809) Bedrooms were toured and observed to be clean and properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Linen storage was also checked and observed to have ample supply of clean linen, comforters, and towels in facility. Bedrooms and kitchen/dining area has a smoke/CO detector that are functional. Bathrooms were observed to be clean, sanitary and with necessary supplies. The appropriate grab bars and mat in the shower. Hot water temperature measured at a range of 117.7°F to 118.9°F and within the required range. Resident’s personal hygiene supplied will be kept separate in their private room. Towels and washcloths are not shared. Kitchen Area is observed to be clean and sanitary. Sharps are locked and stored in a kitchen drawer. Toxins, cleaning solutions, and soap stored and locked under the kitchen sink. Laundry Area: LPA observed detergent, toxins and cleaning supplies locked an inaccessible to residents in kitchen cabinet. The washer and dryer machines appeared to be working and in good condition. Fire extinguisher was observed to be located between kitchen and dining area. Fire extinguisher were observed to be operable with purchased date 07/01/2025. Food: LPA observed at least two (02) days perishable and seven (07) days non-perishable food at the facility that is properly stored. Frozen foods are wrap and stored properly as well. Food storage and preparation areas are clean. Medication: At the time of this visit there were no medications. First aid kit was observed to be complete and locked in office area cabinet inaccessible to residents in care. Garage is detached from the house and observed to be locked and under construction. Administrator indicated the garage is currently being converted into an Accessory Dwelling Unit (ADU). Surrounding Grounds: The front grounds of the facility are well landscaped. All passageways and stairways were observed to be clear from obstruction. The outdoor area was enclosed, and there no body of water. Resident Records: There were no resident records to review at the time of this visit. Staff records were reviewed and observed the following: criminal record clearances, associated to this facility and cardiopulmonary resuscitation (CPR) and first aid were updated. Administrator's certificate was observed to be current. There is no health and safety issue observed during this visit. Exit interview conducted. A copy of this report issued.the state’s words, verbatim · CDSS document, Jul 1, 2025

Type of visit: Case Management - Other

At 10:00 AM, Licensing Program Analyst (LPA) Huma Rahimi attempted to conduct an unannounced Case Management - Other to deliver amended complaint report with a complaint control # 31-AS-20250220180232. LPA rang the bell and no one opened the door. LPA contacted the Administrator Elena Kordonsky via telephone and disclosed the reason for the visit. Initially, LPA was informed that a staff will arrive to provide access to the facility and sign the amended complaint report within 30 minutes. However, no staff arrived within the 30 minutes time frame. LPA contacted the Administrator via telephone again and LPA was informed that due to the current census being zero (0), all staff are out of town. Therefore, no staff are available to provide access to LPA to enter the facility or sign the report. Furthermore, LPA was informed that the Administrator is also unable to come to the facility to sign the report. LPA was informed that the Administrator will come to the Regional Office (RO) in Woodland Hills, California on 06/04/2025 to sign the report. Therefore, LPA will meet with the Administrator at RO to sign this report and the above mentioned amended complaint report on 06/04/2025. No deficiency issued. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jun 3, 2025

Allegation investigated: Staff did not ensure catheter care was being provided to resident Resident’s incontinence care was neglected in the facility

At 1:00 p.m. on 04/17/2025 Licensing Program Analysts (LPAs) Nicholas Reed and Huma Rahimi conducted an unannounced complaint visit. LPA met with the new administrator, Elena Kordonskiy, and disclosed the reason for the visit. To investigate the allegations above, LPA Duguma conducted an initial visit on 08/15/24 and requested documents at 02:15 PM and interviewed Staff #1 (S1) between 3:00 PM to 03:30 PM. During records request, S1 stated they cannot provide resident or staff documents as they do not have access. S1 then provided what documents they had for Resident #1 (R1) and stated they are no longer in the facility. R1 was not in the facility at the time of the visit. LPA Duguma returned on 10/30/24 but the visit was abruptly ended. LPAs Reed and Rahimi also conducted a subsequent visit on 02/28/25 and toured the facility at 10:15 a.m., interviewed residents and staff between 10:30 a.m. and 12:45 p.m., and conducted a record review at 1:00 p.m. Today, LPA requested R1’s records. No records were available for review. LPAs toured the facility at 1:45 p.m. The licensee and new administrator were present. Substantiated The administrator stated there are no other staff or residents currently. Due to the lack of records and eyewitnesses during this investigation, LPA Reed referenced pertinent interviews and record review of R1’s records from investigation of complaint # 31-AS-20240730093716 on 08/06/24. Regarding the allegations "Staff did not ensure catheter care was being provided to resident" and “Resident’s incontinence care was neglected in the facility”, it was alleged that facility staff did not provide catheter care for R1 which led to their hospitalization on 08/07/24 for a urinary tract infection (UTI) with a foul odor. Interview with the former administrator at 9:35 a.m. on 08/06/24 revealed R1 was hospitalized on 07/26/24 for ‘excessive eating and drinking’. R1 returned with a catheter and home health services to assist with catheter care. The facility refused R1’s home health agency from entering the facility and instead used their own home health agency and in-house nurse. Follow up interview with the former administrator around 10:30 a.m. on 02/28/25 revealed the in-house nurse visited R1 once and said that the catheter only needed to be changed once per month. Therefore, no catheter care was provided. The former administrator also noted that the facility did not obtain refills of R1’s medications and did not assist with R1’s medications at the request of R1’s friend. Interview with S1 at 10:10 a.m. confirmed that the facility did not assist with R1’s medications for at least one month at the request of R1’s friend. Interview with R1’s friend at 11:00 a.m. on 08/06/24 revealed that they were not R1’s responsible party and were not on any of R1’s admission documents. R1’s friend noted that they told the former administrator to wait for all physician’s orders to arrive before assisting with medications and incontinence care. Interview with R1 at approximately 12:00 p.m. on 02/28/25 revealed they were never visited by a nurse or provided care for their catheter. When LPA visited the facility on 08/06/24, LPA observed R1 walking with their catheter bag in a dirty 5-gallon bucket. Record review of R1’s records on 08/06/24 at 10:30 a.m. revealed R1 had a history of UTI. No staff trainings were available regarding catheter care. No physician's orders for R1's catheter were present. Interview with the licensee at approximately 10:00 a.m. on 02/28/25 revealed they did not know where records were or if staff had any trainings. Six (06) out of six (06) residents interviewed on 02/28/25 had no pertinent information about R1. Based on observations, interviews, and record review, staff did not provide catheter care or incontinence care to R1 and had no training in catheter care. Home health also did not assist with R1's catheter care. Therefore, the allegations are deemed SUBSTANTIATED at this time. A deficiency is cited on the corresponding LIC 9099-D page. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Apr 17, 2025 · control 31-AS-20240807095448

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87623(b)(1) · Plan of correction due date: Apr 18, 2025

87623 Indwelling Urinary Catheter (b)... the licensee shall be responsible for the following: (1) Ensuring that insertion and irrigation of the catheter shall be performed by an appropriately skilled professional. Based on interviews, observations, and record review, the licensee did not comply with the section cited above by not providing or arranging catheter care for Resident #1 (R1) leading to their UTI which posed an immediate Health, Safety, or Personal Rights violation to persons in care.the state’s words, verbatim · CDSS document, Apr 17, 2025

Plan of correction: The licensee has agreed to conduct an in-service training for themself and the adminsitrator on the cited section and submit proof of training by the POC due date.

Allegation investigated: Staff unable to meet client's needs.

This is an amended report t to clarify the facts of the original report issued 04/17/2025. At 1:00 p.m., Licensing Program Analyst (LPA) Huma Rahimi and Nicholas Reed conducted an unannounced subsequent visit to deliver the findings of the complaint. LPA met with the Administrator Elena Kordonsky and disclosed the reason for the visit. Entrance interview conducted. An initial complaint visit was conducted on 02/28/2025. On this day LPAs requested resident and staff roster at 10:10 a.m. At 10:20 a.m., LPAs conducted a physical plant tour. Between 10:30 a.m. – 1:00 p.m., LPAs conducted an interview with the Licensee, Administrator, one (1) Staff, six (6) out of six (6) residents. On 02/26/2025, LPA Rahimi conducted a Community Care Licensing facility file review of the facility’s plan of operation pre-admissions policy and procedures. Continue on LIC 9099C Substantiated Allegation: Staff unable to meet client's needs. The complainant’s concern was that the Licensee/Administrator unknowingly accepted a resident who had a violent behavior. To investigate this allegation LPAs requested R1’s facility records for Resident #1 (R1), which include but is not limited to a Pre-placement Appraisal, Appraisal Needs and Service Plan, Physicians Report, Admissions Agreement, ID Emergency Sheet, and training for staff, however the documents were not provided. Interview with the Administrator revealed that they had not done a complete preplacement assessment prior to accepting R1. The Administrator did not follow the facility’s plan of operation pre-admissions policy and procedures. In addition, the facility caregiver was not provided appropriate training based on R1’s needs. As a result of this the licensee was not familiar with the resident needs and historical behavior. On 02/16/2025, R1 refused prescribed medications and food. At some time during the day R1was not doing well and attempted to exit the facility through the living room sliding door and broke the glass door. The staff attempted to provide aid to R1, however R1 exhibited violent behavior towards staff and resident #2 (R2) in care. R2 was hit by R1, no injury noted according to the Administrator. Staff #1 (S1), present during the incident needed medical attention and drove himself to the hospital. Moreover, LPAs conducted interviews with six (6) out of six (6) residents who informed LPAs that they are made to stay in their rooms and their care needs are not being met by the facility staff. Lastly, during the visit, LPAs observed that resident’s medication, meals, incontinent, and other needs were not taken care of. Based on the lack of documentation, interviews, and LPA’s observation this allegation is Substantiated. Deficiencies and appeal rights issued. Exit interview conducted copy this report signed and delivered.the state’s words, verbatim · CDSS document, Apr 17, 2025 · control 31-AS-20250220180232

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c)(2)(A) · Plan of correction due date: Apr 24, 2025

Personnel Records-(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: (A) Trainer's full name; This requirement is not met as evidenced by: Based on LPA's observation and interview the licensee did not comply with the section cited above. Upon request of the staff training records the licensee was unable to provide which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 17, 2025

Plan of correction: The Licensee will complete all the required trainings for all of the staff and forward proof of the completed required training to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(a) · Plan of correction due date: Apr 24, 2025

87457(a) Pre-Admission Appraisal - General:(a) Prior to admission, the prospective resident and his/her responsible person, if any, shall be interviewed by the licensee or the employee responsible for facility admissions. Based on interviews and resident records review the licensee failed to conduct a proper preplacement evaluation with R1 to make sure the facility was suitable for R1 which is a potential health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Apr 17, 2025

Plan of correction: The Licensee agreed to hire a licensed vendor and provide training regarding this regulation. The name and contact information will be provided to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a)(3) · Plan of correction due date: Apr 24, 2025

87208 Plan of Operation (a) The licensee shall have and maintain....The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so ....: (3) Statement of admission policies and procedures regarding acceptance of persons for services. This requirement is not met as evidenced by: Based on record review, the facility did not adhere to its plan of operation regarding the admission policies and procedures by accepting R1 without knowing his/her care needs which poses a potential risk to the health, safety, or personal rights of clients in care.the state’s words, verbatim · CDSS document, Apr 17, 2025

Plan of correction: The Licensee agreed to hire a vendorized vendor and get a training regarding this citation and get familiarized with their own plan of operation policies and procedures. Submit the vendor name, contact information, and the training certificates upon completion to LPA by POC due date.

Type of visit: Case Management - Deficiencies

At approximately 10:20 a.m. on 03/04/25 Licensing Program Analyst (LPA) Nicholas Reed and Licensing Program Manager (LPM) Naira Margaryan conducted an unannounced case management visit. Today's case management visit was conducted in conjunction with complaint investigation #31-AS-20250303144817 to issue previously identified deficiencies in the facility from a case management visit on 02/28/2025. LPA and LPM were unable to gain entry to the facility after several attempts. LPA called the administrator at 10:48 a.m. and disclosed the reason for the visit. The administrator stated their were no staff or clients at the facility today. The administrator’s representative joined the call and spoke for the administrator. The administrator’s representative stated they were unable to attend this visit at the current time and asked to reschedule the visit. During Licensing visit conducted on 02/28/2025 the following deficiencies were observed by the LPAs Huma Rahimi and Nicholas Reed. Fire Safety. Blocked and locked emergency exit. (Bedroom #2) The emergency exit was blocked with boxes and the doorknob was missing. The door was locked. Fire clearance. Facility retained non-ambulatory resident R6. Fire clearance is approved to retain ambulatory residents only. Criminal record clearance and association Staff present in the facility without criminal record clearance or association to the facility. 2nd offense within 12 months. There was an insufficient number of competent staff to assist residents. Staff working at the facility, Staff #3 (S3), indicated that they had no knowledge of the English Language to communicate. Incontinence care was not provided. Facility had strong odor of urine and other foul smell and residents’ pants were wet. Around 1:30pm, residents complained that they did not have lunch. Alteration of existing facility sketch. The bedroom #3 that was identified as a residents room was converted to the staff room and the the space adjacent to the living room separated with the doors, was used as a residents room and was marked as a room 1. Medication assistance was not provided. Residents did not receive their medication for about 3 days. Medication records were incomplete and at least 3 residents' medications were not refilled. Residents’ files were missing/incomplete. Hospice and or home care records were not present or incomplete. LPAs observed that at list 3 residents files are missing and other residents’ files were incomplete. Hospice/Home care records for residents either were missing or were incomplete. False claims The Licensee rmisinformed the the Glendale Police Officer about Facility ownership and staff that was working at the facility. Licensee accountability- Licensee claimed that he had no knowledge what transpired in the facility on 02/27/25 and that staff #1 (S1) does not work at the facility. Medication assistance. Staff present at the facility had no knowledge how to provide medication assistance to facility residents. All noted deficiencies were discussed on 02/28/25 between LPM Margaryan and the administrator. All deficiencies were cited and citations were recorded on the corresponding LIC809-D. Civil penalties were issued for deficiencies posing immediate health and safety hazard to residents in care. Exit interview conducted?? Appeal rights discussed? A copy of the report will be provided via email for signature.the state’s words, verbatim · CDSS document, Mar 4, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(1) · Plan of correction due date: Mar 5, 2025

87202 Fire Clearance. (a) All facilities shall maintain a fire clearance... the licensee shall... obtain an appropriate fire clearance approved by … fire department (1) Non-ambulatory persons. This requirement was not met as evidenced by: Based on observations, interviews, and record review, the licensee did not comply with the section cited above in (01) resident, Resident #6, who was non-ambulatory which posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 4, 2025

Plan of correction: The deficiency has been cleared at this time due to the facility having no staff or residents.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(1) · Plan of correction due date: Mar 5, 2025

87355 Criminal Record Clearance (e) All individuals ... shall prior to working... in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above by Staff #2 not having a criminal background clearance or association to the facility which posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 4, 2025

Plan of correction: The deficiency has been cleared at this time due to the facility having no staff or residents.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Mar 5, 2025

87203 Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. Based on observations and interviews, the licensee did not comply with the section cited above in blocking the emergency exit door in Bedroom #2 with debris, which posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 4, 2025

Plan of correction: The deficiency has been cleared at this time due to the facility having no staff or residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(d) · Plan of correction due date: Mar 14, 2025

87465 Incidental Medical and Dental Care (d) If the resident is unable to determine his/her own need for a prescription... facility staff designated by the licensee, shall be permitted to assist the resident with self-administration. This requirement was not met as evidenced by: Based on observations and interviews, the licensee did not comply with the section cited above by not assisting Resident #4 with their medications which posed a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 4, 2025

Plan of correction: The deficiency has been cleared at this time due to the facility having no staff or residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(1) · Plan of correction due date: Mar 14, 2025

87465 Incidental Medical and Dental Care (h) The following requirements shall apply… (1) Medications shall be centrally stored... (C)(2)…Centrally stored medicines shall be kept in a safe and locked place that is not accessible. This requirement was not met as evidenced by: Based on observations, the licensee did not comply with the section cited above by not locking the refrigerator or making the medications inside inaccessible to residents which posed a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 4, 2025

Plan of correction: The deficiency has been cleared at this time due to the facility having no staff or residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411 · Plan of correction due date: Mar 14, 2025

87411 Personnel Requirements – General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on observations and interviews, the licensee did not comply with the section cited above through demonstrated incompetence to care for residents on 02/28/2025 which posed a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 4, 2025

Plan of correction: The deficiency has been cleared at this time due to the facility having no staff or residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87305(a) · Plan of correction due date: Mar 14, 2025

87305 Alterations to Existing Building or New Facilities. (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met as evidenced by: Based on observations, interviews, and record review the licensee did not comply with the section cited above by altering the front area into a bedroom for residents without updating facility sketch, which posed a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 4, 2025

Plan of correction: The deficiency has been cleared at this time due to the facility having no staff or residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87456(a)(3) · Plan of correction due date: Mar 14, 2025

87456 Evaluation of Suitability for Admission. (a)Prior to accepting a resident for care... the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above by not obtaining recent medical assessments for Resident #5 and Resident #6 which posed a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 4, 2025

Plan of correction: The deficiency has been cleared at this time due to the facility having no staff or residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87207 · Plan of correction due date: Mar 14, 2025

87207 False Claims - No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement was not met as evidenced by: Based on interviews and observations, the licensee did not comply with the section cited above by misleading Glendale Police about facility ownership and staffing which posed a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 4, 2025

Plan of correction: The deficiency has been cleared at this time due to the facility having no staff or residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Mar 14, 2025

87506 Resident Records. (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met as evidenced by: Based on observations and record review, the licensee did not comply with the section cited above by not maintaining a complete facility file for Resident #5 and Resident #6 which posed a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 4, 2025

Plan of correction: The deficiency has been cleared at this time due to the facility having no staff or residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(b)(11) · Plan of correction due date: Mar 14, 2025

87506 Resident Records. (b) Each resident’s record shall contain at least the following information: (11) The documentation required by Section 87611 for residents with an allowable health condition. This requirement was not met as evidenced by: Based on observations and record review, the licensee did not comply with the section cited above by not maintaining medical documents for Resident #5 and Resident #6, which posed a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 4, 2025

Plan of correction: The deficiency has been cleared at this time due to the facility having no staff or residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87205(a) · Plan of correction due date: Mar 14, 2025

87205 Accountability of Licensee Governing Body. (a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility. This requirement was not met as evidenced by: Based on interviews and observations, the licensee did not comply with the section cited above by stating they were unaware of facility affairs on the night of 02/27/2025 which posed a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 4, 2025

Plan of correction: The deficiency has been cleared at this time due to the facility having no staff or residents

Allegation investigated: Licensee is operating beyond the scope of their license

At 10:00 a.m. on 02/28/25 Licensing Program Analysts (LPAs) Nicholas Reed and Huma Rahimi conducted an unannounced complaint visit. LPA met with the licensee and disclosed the reason for the visit. To investigate the allegation above, LPAs toured the facility at 10:15 a.m. today, interviewed residents and staff between 10:30 a.m. and 12:45 p.m., and conducted a record review at 1:00 p.m. of pertinent records, including but not limited to an admission agreement, medical assessment, and care plan. Regarding the allegation “Licensee is operating beyond the scope of their license” it was alleged that the facility had eight (08) residents in care as of 02/27/2025. LPAs observed six (06) residents in the home today. LPAs reviewed facility files of four (04) out of six (06) current residents. Two (02) residents did not have files which were available for audit. This deficiency is addressed on a corresponding LIC 809 page. Substantiated All four (04) resident files reviewed showed all residents have been admitted since or prior to 01/27/2025. Interview with the administrator confirmed that the facility provided care and supervision to at least seven (07) residents for the past week. The administrator stated Resident #8 (R8) returned from the hospital on the evening of 02/27/2025 but was removed from the facility within hours of returning. Based on interviews, record review, and observations, the facility provided care and supervision beyond their licensed capacity. Therefore, the allegation is deemed SUBSTANTIATED at this time. A deficiency is issued on the corresponding LIC 9099-D page. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Feb 28, 2025 · control 31-AS-20250228100858

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87204(a) · Plan of correction due date: Mar 3, 2025

87204 Limitations - Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. Based on interviews, record review, and observations, the licensee did not comply with the section cited above by having (08) residents in care which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 28, 2025

Plan of correction: As of today, the facility is within their capacity. The licensee has agreed to conduct and submit an in-service training by the POC due date.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

At 10:00 AM, Licensing Program Analysts (LPAs) Huma Rahimi and Nicholas Reed conducted an unannounced initial complaint visit. LPAs met with the Licensee Albert Khachatryan and contacted the Administrator via telephone and explained the reason for the visit. LPAs toured the facility at 10:15 a.m. today, interviewed residents and staff between 10:30 a.m. and 12:45 p.m., and conducted a record review at 1:00 p.m. Between 10:00 a.m. and 3:00 p.m. LPAs Nicholas Reed and Huma Rahimi noted the following deficiencies: Upon entering at approximately 10:00 a.m., LPAs noted a strong, foul odor near the main entrance. LPAs could smell it from the dining room. Later, around noon, LPAs smelled the strong odor as well as a strong smell of urine. LPA Reed called the administrator at 11:45 a.m. The administrator noted a resident, Resident #7 (R7), passed away last night and the odor is likely from that. During the facility tour, LPAs observed two (02) boxes blocking access to the immediate exit of Bedroom #2. Additionally, the door had an auditory alarm on it, but there was no handle, and the door was locked. LPAs reviewed the facility sketch in which this door was noted to be an emergency exit. Facility fire clearance was approved to retain 6 ambulatory residents. However, during licensing visits, LPAs observed a non-ambulatory wheelchair bound Resident #6 (R6) residing at the facility. During the course of investigating complaint # 31-AS-20250220180232, the administrator also noted that they did not have a medical assessment for Resident #8 (R8) available for audit. The facility also did not have any records for Resident #5 (R5), R6, and R7. File were incomplete for Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), and Resident #4 (R4). Around 1:10 p.m. today, R4 came to the dining room and noted lunch had not yet been served and they had not received their medication. R3 and R6 also noted they had not received their blood pressure medication for a few days. When the licensee removed R4’s medication from the dining room refrigerator, LPAs observed that the medication was unlocked and accessible. Furthermore, the licensee and R4 did not know how to administer the medication, so R4 did not take their medication at that time. An officer from the Glendale Police Department arrived around 1:30 p.m. to investigate alleged elder abuse. When the officer interviewed the licensee at approximately 2:00 p.m. today, LPA heard the licensee tell the officer that although they were present last night when police came and the licensee was not aware of which residents were in the facility at the time. The licensee also stated that they were not the owner of the facility, Staff #1 (S1) did not work at the facility, and that they did not speak English well enough to answer any more questions. LPA Reed called the administrator around 2:15 p.m. today and asked why Staff #2 (S2) was not associated to the facility, had no criminal background clearance, and had no file. The administrator stated S2 was in training for about two (02) weeks and had to be fired. LPA noted that S2 was observed by a credible source last night in the facility and stated they were the administrator. At approximately 4:00 p.m. today, LPAs were notified by the administrator that the licensee had been arrested and all six (06) residents were left in the facility without care and supervision. The administrator noted the nighttime caregiver, Staff #3 (S3), was about an hour away from the facility. Due to emergency circumstances, Licensing Program Manager Naira Margaryan along with Long Term Care Ombudsmans (LTCOs) Rachel Tate and Eriselda Herrera arrived to the facility between 5:00 p.m. and 5:30 p.m. at which time residents were left unattended and 4 police officers were present at the facility. LPM Margaryan and Police Officers made a phone contact to the Administrator Armine Avetisyan, and she refused to come to the facility due to personal health issues. No other staff arrived to the facility. One individual was observed outside of the facility. They refused to identify themselves. LPM and LTCO overheard the individual arguing with the police officers regarding the life camera(s) installed on the facility door. The individual left the facility after short while. Due to time constraints, LPAs were unable to address all noted deficiencies and complete the report. LPAs will revisit the facility at a future date to issue deficiencies as part of a case management visit. No staff was present at the facility to sign this report.the state’s words, verbatim · CDSS document, Feb 28, 2025

Type of visit: Office

An informal meeting was held today at the Woodland Hills Regional Office. The purpose of this meeting was to discuss recent issues of non-compliance. Present at today’s meeting were: Armine Avetisyan, Administrator, Albert Khachatryan, Licensee, Knarik Panossyan, Previous staff member, Angela Whittaker, Regional Manager (RM) , Eva Miller, Licensing Program Manager (LPM), and Licensing Program Analyst (LPA) Melissa Spaeth. The informal conference process was explained to the Administrator. Additionally, they were also informed that this Informal Conference is part of the administrative action process and that further non-compliance and/or citations would result in requiring the attendance at a Non-Compliance Conference meeting. Rossmoyne Hills was licensed on 04/30/2024. From the date the facility was licensed to present, the Regional Office (RO) received three (3) complaints. Two (2) out of three (3) complaints have been found Substantiated. On 08/15/2024, LPA Duguma conducted an unannounced initial complaint visit. LPA announced their name, department and explained the reason for the visit with badge in plain sight. Shortly after entering the facility, the Administrator requested details about the complainant and alleged victim over speaker phone. LPA again explained the reason for the visit and that more information will be disclosed as it is an on-going investigation. The Continued on 809-C Administrator then began shouting to the caregiver, “call the police, call the police”. Moments later the police arrived at the facility and LPA was put through unnecessary questioning. Due to harassment, a lack of cooperation and courteousness, the visit was terminated. On 10/30/24, LPA Duguma conducted an unannounced subsequent complaint visit. LPA announced their name, department and explained the reason for the visit with badge in plain sight. During the visit, caregiver refused to answer questions and identify themselves. The Administrator was again contacted and placed on speaker. Both the Administrator and caregiver made accusation of LPA being racist and making fun of staff. Due to harassment, a lack of cooperation and courteousness, the visit was terminated. During today’s conference, the following matters were discussed: Title 22, Division 6, Chapter 8, Article 13. Enforcement 87755 Inspection Authority of the Licensing Agency (a) Any duly authorized officer, employee or agent of the licensing agency may, upon proper identification and upon stating the purpose of his/her visit, enter and inspect the entire premise of any place providing services at any time, with or without advance notice. (b) The licensee shall ensure that provisions are made for private interviews with any resident or any staff member; and for the examination of all records relating to the operation of the facility. (c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the requirements in Sections 87412(f), 87506(d), and 87508(b). Continued on 809-C It was discussed the Administrator will ensure facility staff receive training regarding the purpose of Community Care Licensing visits and to allow access to the facility. Also, the Administrator will ensure the divider located within the living room area is removed. The Administrator was advised to have a back-up Administrator for the facility and provide a copy of the Administrator Certificate to Community Care Licensing. Exit interview conducted and copy of this report was signed and delivered.the state’s words, verbatim · CDSS document, Dec 3, 2024

Type of visit: Case Management - Other

On 10/30/24 at around 1:00 PM, Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced visit. LPA met with unknown individual who refused to identify himself. During the course of investigating complaint #31-AS-20240807095448, the unknown individual contacted the administrator Armine Avetisyan and put her on speakerphone to speak with the LPA. When LPA asked how many caregivers are currently in the facility, the administrator got frustrated and stated, “Well how many people do you see there? You see them, right?” LPA responded, “Well, I see multiple people walking around”. Administrator then states, “There are two caregivers, and the others you see there are owners of the property”. As the LPA was conducting the physical plant tour and greeting residents, LPA asked the unknown individual questions about the physical plant and his every response was “what does it look like”, gesturing with his hands halfway in the air, shoulders shrugged. As LPA was walking back towards the residents, the unknown individual contacted the administrator again and placed the call on speaker. The administrator then accused the LPA of being racist, being sarcastic and making fun of staff. LPA then contacted Licensing Program Manager (LPM) Naira Margaryan who tried to explain the importance of compliance and allowing the LPA to conduct the investigation. As the LPM was explaining, the unknown caregiver stated twice that he was going to sue the LPA. LPM instructed LPA to immediately terminate the visit. As LPA was leaving the facility, the unknown caregiver paused at the door, placed his hand on the lock for an abnormal time and stated, “Next time you come in this house, you better be careful”. It should also be noted that during a previous visit on 08/15/2024, the Administrator began shouting to the caregiver Kanarick Panosyan, “call the police, call the police”. (CONT on LIC809-C) Moments later the police arrived at the facility and began to interrogate the LPA, asked for LPA’s badge and why LPA was at the facility. LPA fully cooperated with the police and explained the reason for the visit. The officers then explained to the LPA that the administrator contacted the police on behalf of the caregiver for their safety and the person who called stated they suspect LPA was falsifying identity, posing as a government agent. The administrator was informed that they may be called in to the Woodland Hills South Regional Office for a meeting. Due to the hostility of the unknown caregiver and administrator, and for the safety of the LPA, no signature at this time.the state’s words, verbatim · CDSS document, Oct 30, 2024

Type of visit: Case Management - Other

At around 2:00 PM on 08/15/24, Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced visit. LPA met with caregiver, Kanarick Panosyan, and disclosed the reason for the visit. During the course of investigating complaint # 31-AS-20240807095448, the caregiver contacted the administrator Armine Avetisyan and put her on speakerphone to speak with the LPA. LPA explained the allegations and the administrator got frustrated and started demanding information. LPA explained the allegations and that more information will be disclosed as it is an on-going investigation. The Administrator then began shouting to the caregiver, “call the police, call the police”. Moments later the police arrived at the facility and began to interrogate the LPA, asked for LPA’s badge and why LPA was at the facility. LPA fully cooperated with the police and explained the reason for the visit. The officers then explained to the LPA that the administrator contacted the police on behalf of the caregiver for their safety and the person who called stated they suspect LPA was falsifying identity, posing as a government agent. The caregiver was informed that the administrator may be called in to the Woodland Hills South Regional Office for an informal meeting. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Aug 15, 2024

Allegation investigated: Facility staff neglected resident

At 9:30 a.m. on 08/06/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with Staff #1 (S1) and disclosed the reason for the visit. LPA and Staff #2 (S2) toured the facility inside and out. To investigate the allegation above, LPA interviewed the administrator at approximately 9:35 a.m. over the phone, S2 at approximately 10:10 a.m., Resident #1 (R1) at 10:30 a.m., and a visitor (V1) at 11:00 a.m., conducted a medication review at 10:20 a.m., toured the facility with S2 at 10:40 a.m., and conducted a records review of documents including but not limited to an admission agreement, preplacement appraisal, case notes, and medical assessment at 10:45 a.m. Regarding the allegation “Facility staff neglected resident” it was alleged the facility did not provide sufficient care for R1. Substantiated Interview with the administrator revealed R1 was hospitalized on 07/26/24 due to excessive eating and drinking. R1 constantly requested food and water, and the facility provided them. R1 returned from the hospital on 08/04/24 with a catheter. The facility did not obtain any discharge paperwork from the hospital. Record review revealed R1 was diagnosed with bipolar disorder, schizoaffective disorder, hypertension, and diabetes type II. The preplacement appraisal noted R1 needed help with medication. R1’s needs and service plan was blank. No care plan to address R1’s care needs were observed. Interview with S2 revealed R1 ran out of all medications two (02) days ago and the facility has not provided medication assistance since then. Review of medications revealed R1’s bottle of Metformin was filled on 06/04/24 with sixty (60) doses and was empty. S2 stated the facility was instructed by V1 not to give R1 any more medications, so the facility did not assist with medications since R1 returned form the hospital. Based on interviews, medication review, and record review, the facility did not follow a care plan to address R1’s needs. The facility also did not sufficiently assist with R1’s medications. Therefore, the allegation is deemed SUBSTANTIATED at this time. This deficiency is cited on the corresponding LIC 809-D page. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Aug 6, 2024 · control 31-AS-20240730093716

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(d) · Plan of correction due date: Aug 16, 2024

87464 Basic Services (d) A facility ... shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal... and providing the other basic services This requirement is not met as evidenced by: Based on interviews, record review, and observations, the licensee did not comply with the section cited above in one (01) out of four (04) residents by not providing sufficient assistance with medication, care, and supervision which poses a potential Health, Safety, or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 6, 2024

Plan of correction: The licensee has agreed to provide a written statement regarding medication assistance for all residents.

Type of visit: Case Management - Deficiencies

At 9:30 a.m. on 08/06/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with staff and disclosed the reason for the visit. LPA and staff toured the facility inside and out. During the course of investigating complaint #31-AS-20240730093716, multiple deficiencies were observed in the facility which were unrelated to the complaint. At approximately 9:40 a.m., LPA observed three (03) staff members working in the facility. At 11:45 a.m. LPA reviewed the staff associated to the facility. At approximately 1:45 p.m. LPA called the administrator to confirm the names, start dates, and associations of staff working in the facility. The administrator confirmed that two (02) out of three (03) staff did not have criminal background clearances or associations to the facility. This deficiency is cited on the corresponding LIC 809-D page. In addition, due to Staff #2 (S2) and Staff #3 (S3) working in the facility for longer than one (01) month until today, a civil penalty is issued in the amount of $1,000 ($100 per day, per staff, up to five (05) days) on the corresponding LCI 421BG page. During the 1:45 p.m. phone interview with administrator, it was revealed that an incident report was not submitted to Community Care Licensing for the hospitalization of Resident #1 (R1) on 07/26/24. This violation of reporting requirements is cited on the corresponding LIC 809-D page. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Aug 6, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e) · Plan of correction due date: Aug 7, 2024

87355 Criminal Record Clearance (e) All individuals ... shall prior to working... in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Based on interview, record review, and observation, the licensee did not comply with the section cited above in () out of () staff not being associated to the facility which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 6, 2024

Plan of correction: The licensee has agreed to associate all staff to the facility prior to their returning to work by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(D) · Plan of correction due date: Aug 16, 2024

87211 Reporting Requirements (a) Each licensee shall furnish... (1) A written repor... within seven days of ... (D) Any incident which threatens the welfare, safety or health of any resident This requirement was not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above in one (01) hospitalozation of R1 which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 6, 2024

Plan of correction: The administrator has agreed to submit an incident report for the event and a written statement confirming the section has been reviewed.

Type of visit: Prelicensing

At 10:30am, Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an announced Pre-Licensing visit to this facility and met with the Administrator. This is an initial application. The purpose of today’s visit is to inspect the facility to ensure that it maintains compliance under California Code of Regulations, Title 22, Division 6. Today’s site visit consisted of LPA touring the physical plant inside and outside and observed the following: Facility Fire clearance was conducted on 11/21/23 and approved for six (6) Ambulatory residents only. The facility has dual carbon monoxide and smoke alarm system. There is a fire extinguisher located in the kitchen with a date of purchase of 03/21/2024. There will be a functioning telephone on the premises. An emergency exit plan/sketch is posted in each bedroom and in the hallway wall with other posting requirements. There are three (3) bedrooms designated for resident use. Bedrooms were observed to be appropriately furnished. There are one in a half (1.5) bathrooms in the facility. Bathrooms have non-skid mats and appropriate grab bars. Trash cans were observed to have closed tight fitting lids. The common areas (living room, kitchen, and dining areas) were appropriately furnished, and lighting was adequate. The living room has a television and comfortable furniture. Residents, staff records and medication will be stored in a locked cabinet by the administrator's desk. There is one (1) first aid kit and is readily available. The kitchen knives will be stored in a locked drawer in the kitchen. The kitchen cleaning supplies will be stored in a locked cabinet as well. Laundry detergents, cleaning supplies and other toxins will be stored in locked kitchen cabinet. LPA observed the garage to be locked and inaccessible to residents in care. Facility appears to be clean and in good repair. Appliances in the kitchen appeared to be functional. There will be a sitting area in the backyard for residents to conduct outdoor activities. The outdoor, front and back yards were free of any obstruction. There is no body of water. Component III was conducted with applicant. No deficiencies issued with this report. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. Exit interview was conducted. A copy of this report was signed and delivered.the state’s words, verbatim · CDSS document, Apr 16, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): none COMP II Participants: Armine Avetisyan Interview Method: Telephone interview On March 5, 2024, 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. General Provisions 3. Staffing requirements & Training 4. Pre-Licensing readinessthe state’s words, verbatim · CDSS document, Mar 5, 2024