Saint Leo's Helping Hands

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived unannounced at the facility to conduct the required annual inspection. The LPA was greeted by staff and informed them of the reason for the visit. The staff contacted the Administrator on the phone and informed them of the visit. The Administrator said they would arrive at the facility in 35 minutes. The LPA and the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. The fire extinguisher was last purchased on 01/30/2026. The LPA observed required postings throughout the common space. The Living room area has a chimney that is covered and inaccessible to residents in care. KITCHEN: Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The hot water temperature measured at 112.8 degrees Fahrenheit. The medications are locked in a file cabinet located in the living room area. BEDROOMS: There are four (4) residents’ bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Washer and dryer are located adjacent to the kitchen area. A locked cabinet is located in this room with cleaning supplies and detergents. BATHROOMS: Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured within the regulations. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is one side gate for client use and are single-latched. No bodies of water noted. Due to time constraints, LPA Urena will return on another date to complete the Annual inspection. No citations were issued. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Apr 22, 2026

Allegation investigated: Personal Rights-Questionable Death

Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA Urena was greeted by the staff, and the staff contacted the Administrator on the telephone. The Administrator stated they would arrive at the facility soon to meet with the LPA. The LPA met with the Administrator and explained the reason for the visit. On 06/12/2025, the Woodland Hills North (WHN) Regional Office (RO) received a complaint alleging that the Saint Leos Helping Hands facility staff neglected the care of Resident #1 (R1) resulting in R1’s death, which occurred at Valley Presbyterian Hospital on 5/28/2025. On 06/12/2025, the RO referred this case to the Investigations Branch (IB). The complaint was initially assigned to Investigator Amina Luckett. On 07/22/2025, the investigation was reassigned to Investigator Jose Santana. Continues on LIC 9099C (page 2.) Unsubstantiated Pg. 2 On 06/13/2025, Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegation listed above. The LPA was greeted by staff and contacted the Administrator. The Administrator Anahit Balasanyan arrived shortly thereafter, and the LPA informed them of the reason for the visit. The Administrator stated that they had recently become the administrator for the facility. The LPA requested documents pertinent to the investigation. The Administrator was advised that the complaint was referred to the Investigations Branch (IB). R1 resided at this location, prior to licensure when operating unlicensed from approximately 08/30/2024 through 01/17/2025. On 01/17/2025, R1 was hospitalized and discharged to a skilled nursing facility on 01/23/2025 until 03/28/2025. On 03/28/2025, R1 was discharged to another unlicensed location until 04/12/2025. R1 returned to this location on 04/12/2025 and remained until hospitalized on 05/13/2025. The facility’s license was granted on 04/28/2025. On 05/14/2025, the Department received complaint control # 29-AS-20250514101524 which is currently pending investigation. On 06/23/2025, Investigator Luckett issued a subpoena to the Los Angeles County Department of Medical Examiner requesting R1’s autopsy records. On 07/07/2025, Investigator Luckett requested any police reports pertaining to R1 from the Los Angeles Police Department (LAPD). On 07/23/2025, a request for Emergency Medical Services (EMS) records was submitted, and a subpoena for records at Valley Presbyterian Hospital was issued. On 07/23/2025, Investigator Santana conducted a telephone interview with a LAPD Detective. On 07/24/2025, a review of EMS records was conducted. Continues on LIC 9099C page 3. Page 3. On 08/01/2025, Investigator Santana conducted a telephonic interview was conducted with the assigned investigator at the County of Los Angles Department of Medical Examiner (Witness #1(W1)). W1 stated the case was referred to the Medical Examiner due to report of suspected elder abuse. R1 was transported to the Medical Examiner’s office on 06/06/2025. Hospital records from Valley Presbyterian indicated R1 was initially doing okay and was set to be discharged to a skilled nursing facility but a nurse noticed R1 had an acute worsening of their mental status on 05/19/2025. It was discovered through a CT scan that R1 suffered a stroke and brain bleed. R1 was placed on comfort care. W1 did not interview anyone at the facility as a part of their investigation due to R1’s condition improving and the hospital and R1 getting ready to be discharged. On 06/09/2025, R1 had a complete autopsy with the manner of death being determined as natural with underlying hypertension and type 2 diabetes. The autopsy did not show physical evidence of neglect. On 08/04/2025, subpoenas for records were issued to Mission Community Hospital during the time period of 09/01/2024 through 05/14/2025, Owl Western Pharmacy, and skilled nursing facility Brier Oak on Sunset. On 08/05/2025, at approximately 8:05 a.m., a Licensed Vocational Nurse (LVN), (Witness #2) was interviewed. W2 assists sister hospice agency Franklin Hospice. On 05/13/2025, an unknown man from Franklin Hospice contacted W2 and requested W2 visit R1 due to a possible issue with a Foley catheter and R1’s nurse from Franklin Hospice being unavailable. When W2 arrived, the caregiver stated R1 had not taken any medication and was also not taking any fluids. The Foley catheter was in place but there was red tinged urine in the bag. When W2 asked the caregiver where R1’s medication was, the caregiver gave W2 a bin of medication. Continues on LIC 9099C page 4. Page 4. The bin included expired insulin, opened insulin pens, and oral diabetes medication, but the caregiver said they had never given R1 any of the medication. W2 explained to the Investigator that an opened insulin should not be used after 28 days. W2 said R1’s blood pressure was pretty high, and when W2 asked for a blood glucose meter by gesturing, the caregiver handed one to W2. R1’s blood sugar was over 500 mg/dL. W2 called Franklin Hospice to advise they would be calling 911 because R1’s was having a medical emergency unrelated to the reason R1 was on hospice and that R1’s current condition did not appear to be from natural causes. Franklin Hospice had ordered insulin earlier that day, and the Medical Director instructed W2 to administer 10 units of it. When W2 checked R1’s blood sugar level again, it had only gone down to around 400 mg/dL, and the Medical Director may have instructed them to give additional insulin units, but W2 decided to call 911. A total of four clients were taken to the hospital. On 08/06/2024, a subpoena for records was submitted to Franklin Hospice for the time period of 09/01/2024 through 05/14/2025. On 08/07/2025, at approximately 12:50 p.m., an interview was conducted with (Witness #3) at the County of Los Angeles Department of Medical Examiner’s office. W3 said R1’s case became a Medical Examiner case because a detective reported concerns of neglect. W3 determined R1’s cause of death as intracerebral hemorrhage based on a CT scan and autopsy done at their office. R1’s hypertension and type 2 diabetes were listed as other significant conditions because they increase the risk of having a brain bleed, but hypertension is probably the most common cause of stroke. The examination showed R1’s condition was consistent with having had a stroke, and there was no indication of head trauma. W3 found there to be a lot of hemorrhaging in R1’s left brain. The stroke W3 observed was recent relative to the time of her death, but W3 cannot tell if R1 had prior strokes. Continues on LIC9099C page 5. Page 5. W3 said R1’s stroke was spontaneous, but it is difficult for W3 to say whether appropriate treatment of R1’s diabetes could have prevented the stroke and ultimate death. W3 concluded the manner of death to be natural. On 08/07/2025, Investigator Santana obtained a copy of the R1’s autopsy records. A summary of the records reflect R1 was pronounced dead on 05/28/2025 at 0603 hours (at Valley Presbyterian Hospital). W3 of L.A. County Department of Medical Examiner examined R1’s body on 06/09/2025 and found the cause of death to be intracerebral hemorrhage with other significant conditions of hypertension and type 2 diabetes. The manner of death was found to be natural. Law enforcement expressed concerns that facility conditions were unsanitary, but autopsy did not show physical evidence of neglect or abuse. Examination was performed after two weeks of hospitalization. Based on hospital records, W3 summarized R1 was initially taken to Mission Community Hospital on 05/13/2025 but was then transferred to Valley Presbyterian Hospital on 05/14/2025. Janet was admitted for altered mentation, sepsis, and UTI. On 5/19/2025, R1 was stabilized and pending discharge but suffered an acute worsening in mental status. A head CT scan showed new focal hypoattenuation in the left MCA territory, and R1 was later found to have suffered a large ischemic stroke and hemorrhagic conversion. Because R1 was not believed to be a surgical candidate, R1 was placed on DNR/DNI comfort care, and R1 was pronounced dead at 0603 hours on 05/28/2025. On 08/08/2025, at approximately 1:05 p.m., R1’s next of kin (Witness #4) was interviewed. W4 did not have a close relationship with R1 and did not know about R1’s placement or R1’s medical condition but believed R1 had strokes and or seizures as a result of a head injury that occurred 2-3 years ago. Continues on LIC 9099C page 6. Page 6. On 08/08/2025, records from Brier Oak on Sunset were received. Review revealed R1 resided at the skilled nursing from 07/24/2024 through 08/30/2024. At the time of discharge, R1’s active orders included prescriptions for Januvia, Humulin R, and Basaglar KwikPen. Instructions were to inject 30 units from the insulin pen two times a day and use additional injections per sliding scale. On 08/11/2025, records from Mission Community Hospital were received. A review revealed R1 was admitted to Mission Community Hospital at 1940 hours on 5/13/2025 with an admitting diagnosis of hyperglycemia. The LAFD EMS Captain advised that the facility knew nothing about R1 and only provided a box full of medications. According to the Captain, R1 would be unable to return to the facility. In the emergency room, R1 had a blood sugar of 475 mg/dL, and was given 10 units of insulin. A head CT scan showed no acute hemorrhage, hydrocephalus, or mass effect. R1 was not able to ambulate but had no apparent distress, pain, or shortness of breath. R1 was found to have dermatitis on the buttock. R1 was discharged at 0423 hours on 05/14/2025 to Valley Presbyterian Hospital with a blood sugar of 258 mg/dL. Discharge diagnosis was sepsis, with other diagnoses including encephalopathy, type 2 diabetes with hyperglycemia, and hypertension. On 08/13/2025, at approximately 0835 hours, an email request to LAPD Communications Division for the call for service log at the facility address from 01/01/2025 – 05/13/2025 was submitted. On 08/13/2025, a review of records from Owl Western Pharmacy revealed Owl Western Pharmacy filled for R1 glipizide, delivered on 3/19/2025; Lantus, delivered on 3/07/2025; and Humulin R, delivered on 3/07/2025. All of these were prescribed by a physician at Maclay Healthcare Center on 3/06/2025.On 08/14/2025, a subpoena for records was submitted to Maclay Healthcare Center. On 08/15/2025, a review of LAPD’s call for service log revealed a call for service on 04/01/2025 unrelated to R1. Continues on LIC9099C page 7. Page 7. On 08/15/2025, a review of Franklin Hospice records revealed R1 was admitted to Franklin Hospice on a routine level of care on 08/31/2024 after being referred that day by a physician (Witness #5) with a primary diagnosis of hypertensive heart disease. Although the “Narrative Summary of Prognosis Documentation” that was docu-signed by the physician notes R1’s diagnosis as “Hemiplga following cerebral infrc aff left dominant side.” R1’s Plan of Care, which was incorrectly dated 08/13/2025, was drafted by hospice RN. It indicates a health aide would provide R1 with personal care assistance twice a week. For diabetes, R1’s blood sugar would be checked routinely, and caregivers would avoid giving sweets. Caregivers would administer metformin, Januvia, Jardiance, Humulin R KwikPen, and Basaglar KwikPen. RN’s 08/31/2025 Comprehensive Nursing Assessment said R1 was admitted for hemiplegia with other conditions of diabetes, unsteadiness on feet, and generalized muscle weakness. It was noted R1 had a personal history of ischemic heart attack and cerebral infarction without residual. Weekly skilled nursing visits between 09/08/2024 – 01/13/2025 were made by LVN. Caregivers reported R1’s blood sugar was sometimes high and R1 refused insulin at times. The LVN educated caregivers on reportable signs of hypo/ hyperglycemia, with caregivers verbalizing understanding. During some of the LVN’s visits, caregivers reported elevated blood sugar, so the LVN reminded caregivers to consistently monitor and record Janet’s blood sugar levels and to promote healthy eating habits. R1 was discharged from hospice on 01/17/2025 due to hospitalization after complaints of chest pain and trouble breathing. R1 was readmitted to Franklin Hospice on a routine level of care on 03/31/2024 after being referred that same day by same admitting physician, with a primary diagnosis of hypertensive heart disease.During the LVN’s (Witness #6) weekly visits, the LVN made no reference to R1’s diabetes. The LVN’s first visit was on 4/01/2025, but they did not visit again until 04/18/2025. On the 04/24/2025 updated assessment, it noted that caregiver “Anna” was present and actively participated in R1’s care. There was no skin breakdown. No medication refills were needed during that visit. LVN visited again on 04/25/2025 and noted no physical signs of distress, with vitals within normal limits. When LVN visited on 05/13/2025, at around 0900 hours, they noted R1’s blood pressure at 190/98, which was higher than at any prior visit within that certification period. R1 was non-verbal and had a pulse of 101 and respirations at 20. LVN administered Clonidine to address the elevated blood pressure. No safety issues or incidents were reported to the LVN during the visit. Continues on LIC 9099C page 8. Page 8. Later that same day at approximately 1800 hours, hospice nurse W2 visited the facility and noted R1’s blood pressure as 157/101 and temperature at 100.8. W2 documented that they received a call from Franklin Hospice requesting a PRN visit because a caregiver reported R1 was not feeling well. According to office staff, medications were delivered earlier that day. The caregiver brought W2 a box with medications and a bag of medications delivered that day. W2 observed insulin to be opened and likely past 28 days of opening. When W2 assessed R1’s blood sugar it was 476 mg/dl and notified W7. W7 ordered 10 units of insulin. Thirty minutes later R1’s insulin was 469 mg/dL and W2 noticed W7 they would be calling 911 and W7 agreed. On 08/27/2025, an interview was conducted with Staff #1 (S1). S1 stated when they worked at the facility when it was previously unlicensed in June 2024, they checked R1’s blood sugar everyday and gave insulin when instructed by the hospice nurse. On 08/27/2025, an interview was conducted with Staff #2 (S2) who began working at the facility on 05/01/2025. S2 stated they knew R1 was diabetic but R1 was not receiving insulin. On the morning of 05/13/2025, the NOC staff did not mention anything about R1 but S2 noticed R1’s face was red. When the hospice nurse arrived around noon, R1’s blood sugar was high and insulin was ordered. Between 1600-1700 hours, the insulin was received and a different nurse administered it but R1’s blood sugar was still high so 911 was called. On 09/04/2025, an interview was conducted with Witness #7 (W7), Medical Director of Franklin Hospice. W7 was not aware R1 should have been taking diabetes medications both oral and by injection until 05/13/2025 when W2 contacted them regarding R1’s blood sugar. W7 advised W2 to give R1 insulin.On 9/04/2025, at approximately 11:20 a.m., R1’s Hospice Nurse / Licensed Vocational Nurse (LVN) Witness #6 (W6) working for Franklin Hospice was interviewed via Facetime video chat. W6 stated when R1 was discharged from the SNF and returned to hospice, the SNF discontinued R1’s diabetes medications and the RN who readmitted R1 followed the orders. As a result, the facility was no longer required to check R1’s blood sugar. W6 did not recall checking R1’s blood sugar during that time.Continues on LIC 9099C page 9. Page 9. On 09/05/2025, an interview with Licensee Edgar Zatikian with the assistance of the facility Administrator serving as an Armenian translator was conducted. Zatikian owns the facility and works as the sole overnight caregiver. Zatikian denied the facility administering insulin injections to R1 at any time, either before or after being licensed. Zatikian stated when R1 returned in April 2025 they did not return with insulin, Zatikian denied knowing about insulin being observed in the facility by LAFD or W2 on 05/13/2025. Zatikian stated they knew R1 had diabetes, but no one explained why R1 was not receiving diabetes medications. On 09/05/2025, a review of additional records from Maclay Healthcare Center was conducted. When R1 was discharged from the SNF, discharge documents were sent on 03/28/2025 to A Better Solution home health agency with oral diabetes medications and insulin orders and the resident was transported to an unlicensed location. On 09/05/2025 an interview was conducted with Witness #5 (W5) who was the referring physician from Franklin Hospice. W5 stated they no longer work for Franklin Hospice as of August 2025. W5 acknowledged their e-signature on R1’s 03/31/2025 but was unsure whether they signed it because of concerning practices. W5 did not know R1’s medication list and no longer had access to that information. On 09/08/2025, an interview was conducted with Witness #8 (W8). W8 stated R1 was referred to A Better Solutions but when the home health agency went to visit R1 at the unlicensed location they refused services and explained the facility had their own home health or hospice services. On 09/09/2025, a review of pharmacy records prescribed on 04/03/2025 by W7 reflect no medications for diabetes. On 9/11/2025, at approximately 12:35 p.m., R1’s attending Physician at Valley Presbyterian Hospital, Witness #9 (W9) was interviewed via Teams video chat. When asked, W9 stated a lack of diabetes medications could have contributed to R1’s stroke. However, damage to arteries occurs over a span of years and does not happen overnight. Continues on LIC 9099C page 10. Page 10.On 09/12/2025 an interview was conducted with Witness #10 (W10) who is an LVN at Franklin Hospice. W10 stated when R1 was assessed on 03/31/2025, R1 initially refused insulin and blood sugar checks but later agreed. W10 also stated Maclay Healthcare Center did not provide a medication list initially but later provided one. Interviews and record review revealed that on 05/13/2025, R1 was hospitalized for hyperglycemia, and a CT scan was performed on R1; there were no acute findings on R1’s head CT scan at that time. After signs of R1’ condition improvement, the hospital was going to discharge R1 to a skilled nursing facility (SNF), however R1 had a change in mentation on 05/19/2025. A CT scan at Valley Presbyterian Hospital showed that R1 likely suffered a stroke, and additional testing showed presence of multiple additional strokes occurring at the hospital. R1 passed away at the hospital on 05/28/2025. R1’s attending physician was unable to say whether R1’s strokes could have been prevented had R1’s diabetes been properly managed. The County of Los Angeles Deputy Medical Examiner (DME) concluded that R1’s death to be natural and resulting from intracerebral hemorrhage with contributing factors of diabetes and hypertension, furthermore the DME did not find any immediate indicators of abuse or neglect. R1 had a complete autopsy on 6/09/2025, with the manner of death being determined as natural with underlying hypertension and type 2 diabetes. According to the DME, the autopsy did not show physical evidence of neglect. R1’s stroke was spontaneous, but it is difficult for the DME to say whether appropriate treatment of R1’s diabetes could have prevented the stroke and ultimate death. DME concluded the manner of death to be natural. The allegation that R1’s death was due to facility’s neglect, is deemed Unsubstantiated at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 29, 2026 · control 29-AS-20250612112804

Allegation investigated: Staff are not meeting the needs and services of the residents. Staff provided expired medication to a resident. Staff are unable to provide proper documentation for the residents while in care. Unqualified staff is providing care and supervision.

Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent unannounced visit to deliver the findings for the allegations listed above. During today’s visit, LPA Urena was greeted by the staff, and the staff contacted the Administrator on the telephone. The Administrator stated they would arrive at the facility soon to meet with the LPA. The LPA met with the Administrator and explained the reason for the visit. On 05/15/2025, Licensing Program Analyst (LPA) Sandra Urena, along with Captain Cameron Langhans from the Los Angeles City Fire Department conducted an initial 10-day visit to investigate the allegations listed above. The LPA spoke with the Administrator on the phone and explained the reason for the visit. The Administrator arrived shortly thereafter. LPA Urena interviewed the residents and Administrator from approximately 9:45 a.m. to 12:30 p.m. Continues on LIC 9099C page 2. Substantiated Page 2. Staff are not meeting the needs and services of the residents. On the allegation that staff are not meeting the needs and services of the residents; it is the concern of the reporting party (RP) that on 05/13/2025, R1 was found and observed to be altered and bed bound, incontinent with strong smell of urine, rapid respirations and hyperglycemia. At the time of the RP’s observation, the staff present did not speak English, was unable to locate any paperwork or information regarding the R1’s medical history, recent illnesses or baseline mental status. LPA Urena interviewed staff (S1) about the condition of R1 on 05/13/2025. The staff stated that they did not notice any urgent changes in R1 prior to leaving the facility briefly due to a personal emergency. The S1 stated that the cleaning person stayed to keep watch over the residents while the S1 was gone. However, this is when the incident occurred, and the EMT personnel arrived. The Administrator denied knowing that S1 had left the cleaning person to watch over the residents while they were gone. LPA was unable to interview the cleaning person. Based on information obtained through interviews, the staff did not meet the needs and services of the residents when they left residents under the care of a person who did not provide care and supervision to R1 when R1 was found to be in an altered state, rapid respirations and with a strong smell of urine. Therefore, the allegation is deemed Substantiated at this time. Staff provided expired medication to a resident. On the allegation that staff provided expired medication to a resident; it is the concern of the reporting party (RP) that untrained staff provided EMT personnel with a box full of R1’s medication, and upon observation of the medication, EMT personnel observed an expired (03/06/2025) insulin bottle which was prescribed to R1 (a picture of the insulin bottle found at the facility was provided by credible sources). It is not clear if the staff had administered the expired insulin to the R1. To investigate the allegation, the LPA requested a copy of the LIC 622 (Centrally Stored Medication and Destruction Record). The LIC 622 was observed to have outdated entries at the time of the visit, with the last entries made as ‘medication received on 03/10/2025’. No record of the insulin was found on the LIC 622. No medication was available to review on the day of the visit. Continues on LIC 9099C...page 3. Page 3. Based on the record review in addition to the RP’s report, credible witnesses and pictures, the preponderance of the evidence supports that the staff provided expired medication to a resident. Therefore, the allegation is deemed Substantiated at this time. Staff are unable to provide proper documentation for the residents while in care. On the allegation that staff are unable to provide proper documentation for the residents while in care; it is the concern of the RP that staff were unable to provide EMT personnel with the resident’s medical information at the time they arrived to transport R1 to the hospital. To investigate the allegation, LPA Urena conducted an initial visit on 05/15/2025; at this time the LPA requested records pertaining to R1 pertinent to the investigation and interviewed the staff, administrator and residents. The Administrator’s interview revealed that they were not sure why the staff did not provide the R1’s medical records. The Administrator provided to the LPA the following records: LIC 602 (Physician’s Report dated 03/21/2025) and LIC 622 (Centrally Stored Medication and Destruction Record). The LIC 622 was outdated at the time of the visit. The interview with staff revealed that at the time of the EMTs arrival they had stepped out of the facility to attend to a family emergency, consequently they left the cleaning person at the facility for a short period, and the cleaning person did not have access to the residents’ records. Based on the information obtained through credible sources, and interviews with staff, the staff present at the time of the incident were unable to provide proper medical information for the residents while in care. Therefore, the allegation is deemed Substantiated at this time. Continues on LIC 9099C... page 4 Page 4. Unqualified staff is providing care and supervision. On the allegation that unqualified staff is providing care and supervision; it is the concern of the RP that staff present at the facility on the day of the incident were not qualified to provide care and supervision to the residents in care. To investigate the allegation, the LPA interviewed the staff and Administrator. The Administrator denied knowing that staff (S1) left the cleaning person to watch over the residents while S1 attended to a personal emergency. S1 confirmed that they left briefly, and left cleaning person at the facility. S1 claimed they were gone for maybe 15 minutes and when they came back the EMTs had taken the R1 to the hospital. The LPA confirmed via Personnel Report that cleaning person was not associated with the facility at the time of the incident. Based on information obtained via Personnel Report and interviews, unqualified staff were present providing care and supervision to residents in care. Therefore, the allegation is deemed Substantiated at this time. Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies were cited (refer to LIC 9099-D). Citations were issued. Exit interview was conducted. A copy of the report and Appeal Rights were issued.the state’s words, verbatim · CDSS document, Jan 29, 2026 · control 29-AS-20250514101524

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a)(c)(g)-(1-3) · Plan of correction due date: Feb 9, 2026

Personnel Requirements – General (a) Facility personnel shall at all times be …competent to provide the services necessary to meet resident needs… (c) All RCFE staff who assist residents with Personal activities of daily living shall receive initial and annual training as specified in… (g) Prior to employment or Initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (1)Obtain a California clearance or a criminal record exemption as required by law or Department regulations or… This requirement is not met as evidenced by: Based on observation: The licensee did not comply with the section cited above as one person left to care for residents was not competent or qualified to provide the services necessary, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: POC: Administrator stated that they will review regulations as they pertain to Personnel Requirements and will submit Letter to LPA as self certification.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4)(e)(1-4) · Plan of correction due date: Feb 9, 2026

(a)(4)(e)(1-4) The licensee shall assist residents with self-administered medications as needed. (e) For every prescription…medication for which the licensee provides assistance there shall be a signed, dated written order from a physician…maintained in the residents file, and a label on the medication…This requirement is not me as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above as 1 of 6 residents medication reviewed was expired at the time of the visit and not reflected in the LIC 622, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: As of today's visit the Administrator provided proof of training for current working staff.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Feb 9, 2026

87355(e)(2) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: 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 and record review, the licensee did not comply with the section cited above when an uncleared individual was left with residents, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: POC: Cleaning person was no longer at the facility. Administrator understood that individuals cannot be present without clearance.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a)(b)(1-16) · Plan of correction due date: Feb 9, 2026

87506(a)(b)(1-16) Resident Records-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. (b) Each resident’s record shall contain at least the following information… 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 1 of 6 residents records were not available for reviewed for EMT personnel and a full file for the department which included an expired LIC 622, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: POC: Administrator stated that they will review regulations as they pertain residents' records and will submit letter to LPA as self-certification.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit and met with the Licensee Edgar Zatikian and Administrator Ani Navruzyan. This is a new facility application for a Residential Facility for the Elderly (RCFE) for six (6) non-ambulatory residents; one (1) of which may be a bedridden resident(s). Waiver was granted for hospice care for six (6) residents. Fire Clearance was approved on 03/14/2025. Bedridden resident approved in bedroom #4. The LPA, and the applicant toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility will be following Title 22 Regulations. COMMON AREAS: The living room area is equipped with a television, and the fireplace is non-functional and is currently covered with a movable screen. The licensee stated that they will secure the screen to prevent it from being moved. There is a dedicated area for the posting of required documents at the entrance of the facility, and the living room area. Smoke and carbon monoxide alarms were tested and functional at the time of the visit. Medications will be stored in a locked cabinet in the office area located in the corner of the living room area. The residents’ and staff files will be stored and locked cabinets located in the office area. LAUNDRY: There is a laundry area equipped with washer and dryer. The washer and dryer are located in a room next to the kitchen. Detergents and cleaning supplies will be stored in a locked cabinet under the kitchen sink. Continues on LIC 809 C... KITCHEN: Kitchen knives are stored locked and inaccessible in a locked kitchen drawer. A seven-day supply of non-perishable food was available. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen cleaning supplies will be stored and locked under the kitchen sink. Hot water temperature was recorded at 115.6 degrees Fahrenheit. Trash cans have a tight-fitting lid. There were no pesticides or toxins stored near food, or preparation area. The first aid supplies were complete, including current version of a first aid manual. A fire extinguisher is located near the kitchen, which was purchased on 08/14/2024. BEDROOMS: There are four (4) bedrooms for residents in care. Rooms # 2 and 3 will be used as private rooms. Room #4 is approved for one (1) bedridden resident. Rooms # 1 and 4 will be shared rooms; all bedrooms are cleared for non-ambulatory. All bedrooms were supplied with all required bedding and linens. There is sufficient lighting as well as closet and drawer space available. Bedrooms #2 and #3 will need walls painted. Bedroom #1, air vent needs to have dust removed, and ceiling cleared of web. Remove wheelchair from bedroom #2. BATHROOMS: There are three (3) full bathrooms with shower area. One bathroom is a private bathroom located in bedroom #4. Bathroom #1 by the entrance needs to have grab bars added to the toilet, handwashing sign posted, and shower curtain added. Bathroom #2 needs bottom of shower step over area to be sharp. Remove towel rack to make it easier to reach toilet lever. Private bathroom, add handwashing sign. Bathrooms are equipped with toilets and shower grab bars, and non-skid mats. There are sufficient supplies of towels, paper goods and personal hygiene supplies. Hot water delivered was between 115.6 to 119.8 degrees Fahrenheit. Continues on LIC 809C... SURROUNDING GROUNDS/OUTDOOR AREA: The patio is furnished with outdoor furniture for residents’ use, and shade is available. The building has a central entrance for residents and visitors. Left passageway is cleared. Right side area needs to be cleared of debris. Licensee and Administrator were advised that the main sliding gate needs to remain unlocked. Pre-Licensing is incomplete with deficiencies to be resolved by April 14, 2025. Follow up Pre-licensure LIC809 will be generated upon resolution. · Bedrooms #2 and #3 will need walls painted. Bedroom #1, air vent needs to have dust removed, and ceiling cleared of web. Remove wheelchair from bedroom #2. · Bathroom #1 by the entrance needs to have grab bars added to the toilet, handwashing sign posted, and shower curtain added. Bathroom #2 needs bottom of shower step over area to be sharp. Remove towel rack to make it easier to reach toilet lever. · Right side area needs to be cleared of debris. The applicant completed Component III orientation. This report will be sent to the Centralized Application Bureau (CAB). 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. Exit interview was conducted and reviewed with the applicant. A copy of the report was issued.the state’s words, verbatim · CDSS document, Apr 8, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 2 COMP II Participants: Name - Edgar Zatikian CEO/ Ani Navruzyan Administrator Interview Method: Telephone interview On March 12, 2025, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the 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, Mar 12, 2025