Sequoia Grove Assisted Living

Type of visit: Case Management - Deficiencies

Licensing Program Analyst’s (LPA) M. Vega and H. Vang arrived at the facility unannounced to conduct a Case Management for deficiencies. LPA’s were granted entry by Staff 1 (S1), LPA’s met with Administrator - Keghouhy "Kay" Handian a short time later. On 01/22/2026 and 03/18/2026 LPAs requested documents and again though email on 04/22/2026, 04/27/2026 and 05/11/2026, (documents previously requested are for two separate complaints, 24-AS-20260115153001 and 24-AS-20260316153751) by M. Vega. Documents requested are: payment issued by responsible parties for those residents. On 08/13/2026, LPA M. Vega and M. Garza conducted a Case Management requesting the following: admissions agreement for R1 and R2 and payments rendered for R1 (11/14/2024 - 05/30/2025) and R2 (08/13/2022 - 12/31/2024) by responsible parties in the form of bank statements. The deadline for the following documentation to be submitted by close of business 08/20/2026. As of this date, the requested documents have not been submitted by the Administrator. Deficiencies are being cited in accordance with California Code of Regulations, Title 22, Division 6 on the attached LIC 809D. Exit interview conducted and a plan of correction was reviewed and developed with the Licensee. A copy of this report and appeal rights were provided to Administrator, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Aug 28, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87755(c) · Plan of correction due date: Aug 31, 2026

(c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours... Removal of records shall be subject to the requirements in Sections 87412(f), 87506(d), and 87508(b). Based on interviews and record review, the Licensee did not comply with section 87755 when the Licensee did not provide Financial records in the form of bank statements when requested by the department, which is a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 28, 2026

Plan of correction: Administrator stated that will submit Fanancial records in the form of bank statements to LPA M Vega though email on 08/31/2026

Type of visit: Case Management - Other

On 08/13/2026, Licensing Program Analyst (LPA) M Vega and M Garza, completed an unannounced case management visit. LPA met with Administrator - Keghoughy "Kay" Handian and explained reason for visit. This case management visit is being conducted as follow up for documents requested on 01/22/2026 and 03/18/2026 and again though email on 04/22/2026, 04/27/2026, 05/11/2026, (documents previously requested are for two separate complaints, 24-AS-20260115153001 and 24-AS-20260316153751). Documents requested are: admissions agreement for R1 and R2 and payment issued by responsible parties for those residents. During today's visit, LPA requested the following: admissions agreement for R1 and R2 and payments rendered for R1 (11/14/2024 - 05/30/2025) and R2 (08/13/2022 - 12/31/2024) by responsible parties in the form of bank statements. The deadline for the following documentation to be submitted by close of business 08/20/2026. LPA(s) will return at a later date if no documents are received by department by deadline. Conducted tour of facility. While conducting tour, LPAs observed medications unlocked and accessible to residents in care. Tools in covered area unsecured and accessible to residents in care. Cabinets containing chemicals unlocked and accessible to residents in care. Citations were issued under California Title 22. Exit interview was conducted and a copy of this report LIC 809, LIC 809D and appeal rights were provided to administrator for facility records.the state’s words, verbatim · CDSS document, Aug 13, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Aug 14, 2026

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on LPA observation, the licensee did not comply with the section cited above due to Medical room unlocked and accessible to residents in care, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: Administrator will conduct Training with Staff and place sign as reminder to staff. A statement will be provided to the Dept by POC due date explaining action to be taken to correct deficiency.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Aug 14, 2026

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in LPAs observed cleaning supplies, gardening tools, unlocked and accessible to facility residents, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: Administrator will conduct in-service training with staff. A statement will be provided to the Dept by POC due date explaining action to be taken to correct deficiency.

Type of visit: Office

On 08/07/2026, an Non-Compliance Conference (NCC) was held due to concerns observed by the Department during annual inspections and complaint investigations. During the investigation of complaint # 24-AS-20260316153751 and complaint # 24-AS-20260115153001, the Department requested documentation regarding the complaint and have not received the requested documents as of this date. A review of the facility’s compliance history further revealed that several of these deficiencies have previously been discussed with the Licensee Representative/Administrator during prior inspections. Although the Administrator had knowledge of identified concerns, appropriate corrective measures were not implemented. Deficiencies are being cited in accordance with California Code of Regulations, Title 22, Division 6 on the attached 809D. Exit interview conducted and a plan of correction was reviewed and developed with the Licensee. A copy of this report and appeal rights were provided to Licensee, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Aug 7, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(2) · Plan of correction due date: Aug 25, 2026

87405 Administrator - Qualifications and Duties (d) The administrator shall have (2)Knowledge of and ability to conform to the applicable laws, rules and regulations… This requirement was not met as evidenced by, Based on observation, record reviews, and interviews, the Licensee did not comply with section 87405 when the licensee was informed of concerns regarding the facility operations and did not implement corrective measures which is a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 7, 2026

Plan of correction: Licensee agrees to review section 87405 and submit a written statement detialing the steps the facility will take to ensure the requirements for this section is met, to include a target date of when the corrections will be implemented and a list of training topics, to the Fresno CCL office by the POC

From the deficiency page — Deficiency type: Type B · Section cited: CCR87755(c) · Plan of correction due date: Aug 25, 2026

87755 Inspection Authority of the Licensing Agency (c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours… This requirement was not met as evidenced by: Based on interviews and record review, the Licensee did not comply with section 87755 when the Licensee did not provide resident or staff records when requested by the department, which is a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 7, 2026

Plan of correction: Licensee agrees to submit write a statement detailing the steps the facility will take to ensure the requirements of 87755 are met to the Fresno CCL office. Licensee also agrees to provide the requested document to the LPA by the POC

Allegation investigated: Staff did not ensure resident was spoken to in an appropriate manner Staff forced resident to consume food with medications mixed in it Staff did not allow resident to choose her own healthcare provider

On 2/14/2026 Licensing Program Analyst (LPA), M. Garza arrived at the facility for an unannounced complaint visit. LPA met by Care Giver, Marisol Gonzalez explained reason for visit and was permitted entry into the facility. Licensee, Keghouhy “Kay” Handian was contacted and stated they were unavailable to come to the facility. Kay gave permission to complete visit with Care Giver, Marisol. LPA completed a health and safety check on residents in care. Residents observed in common areas and in rooms. LPA toured the facility. During visits LPA completed interviews, toured facility, reviewed documentation provided by Licensee (physicians reports, admission agreements, needs and services plans, functional capabilities, hospice records, personnel report, and resident roster). Based on interviews conducted and records reviewed, the allegation staff did not ensure resident was spoken to in an appropriate manner is SUBSTANTIATED. Interviews disclosed staff failed to maintain a respectful interaction with R1 and forcing them to consume food with medication mixed inside without R1’s approval. Records reviewed and interviews conducted show the facility did not have medical documentation from a physician. The allegation staff forced resident to consume food with medication mixed inside is SUBSTANTIATED. CONT... Substantiated CONT... Records reviewed indicated 2 of 2 residents were on hospice with Bright Horizons. Interview with Licensee indicate this is the hospice agency Licensee is “familiar with” and Licensee “has a preference to use this agency”. Licensee further indicated that 2 of 2 residents on hospice were with placed with another hospice agency and were switched over to Bright Horizons (Licensees preference). Interview statements indicate residents are not provided with the opportunity to select their preferred healthcare provider or that alternative options were given. The allegation staff did not allow resident to choose their own healthcare provider is SUBSTANTIATED. The preponderance of evidence standard has been met per California Code of Regulation, Title 22. The allegations listed above are SUBSTANTIATED. Deficiencies issued on attached 9099D. If not corrected, deficiencies will have a direct impact to residents in care. Exit interview conducted with Care Giver, Marisol. A plan of correction was provided by Care giver and Licensee via telephone and reviewed by LPA. A copy of this report, deficiencies and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 14, 2026 · control 24-AS-20250722081802

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Feb 27, 2026

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidence by: interviews conducted. The licensee did not comply with the section cited above in that staff failed to maintain respectful interactions with R1 and forcing them to consume food with medication inside without R1’s approval. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 14, 2026

Plan of correction: Licensee stated they will provide a plan of correction in writing to CCL no later than 2/17/26. Plan of correction will be completed and documentation will be sent to CCL by POC date as proof of correction.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(5)(D) · Plan of correction due date: Feb 27, 2026

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility…(5)...Assistance with self-administered medications shall be limited to the following: (D) Assistance with self-administration does not include forcing a resident to take medication, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication. This requirement was not met as evidence by: records reviewed and interviews conducted. The licensee did not comply with the section cited above in that R1 did not have a prescription on file to place medications inside their food. Interviews disclosed R1 was forced to take medications without their consent. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 14, 2026

Plan of correction: Licensee stated they will provide a plan of correction in writing to CCL no later than 2/17/26. Plan of correction will be completed and documentation will be sent to CCL by POC date as proof of correction.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(a)(3) · Plan of correction due date: Feb 27, 2026

87633 Hospice Care of Terminally Ill Residents (a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill…when all of the following conditions are met: (3) Hospice agency services are contracted for by each terminally ill resident…not by the licensee on behalf of a resident or prospective resident. These hospice agency services must be provided by a hospice agency both licensed by the state and certified by the federal Medicare program. This requirement was not met as evidence by: records reviewed and interviews conducted. The licensee did not comply with the section cited above in that 2 of 2 residents receiving hospice care were changed from their original agency selection to the licensee’s "preferred agency". This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 14, 2026

Plan of correction: Licensee stated they will provide a plan of correction in writing to CCL no later than 2/17/26. Plan of correction will be completed and documentation will be sent to CCL by POC date as proof of correction.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) M. Vega arrived at the facility unannounced to conduct a required annual visit. Staff allowed LPA into facility and contacted Administrator - Keghouhy Handian. Administrator was unable to attend but gave permission to Staff 1 (S1) Ana Petrosyan to sign documents. Entrance interview conducted. Census of 5 residents with capacity of 6. LPA, along with the S1 toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: The Kitchen and Dining area were clean and sanitary and in good repair. All pathways observed were free of obstruction and hazards. Knifes and sharp objects were locked in drawer and inaccessible to residents. The refrigerator and freezer were within operating temperature, 43 F and 0 F. They are also clean and sanitary with no spoiled food. There were at least 2 days of perishable food and 7 days of non-perishable food stored. Fire extinguishers are fully charged and were last serviced 07/18/25. Hardwired smoke and carbon monoxide detectors and fire doors were tested and operational and all were functional at the time of the visit. LPA observed exit alarms by all doors which were functional and operating. Walked though residents rooms, observed All bedrooms had the required furnishing: Lamps, Chairs, a Bed, and storage for clients' clothing. All bedrooms were sanitarily clean and free from trip hazards. All bedrooms were in good repair. Medications are locked in a closet located near the hallway. Cleaning supplies are stored in a locked cabinet in the laundry room. Bathroom water temperature was tested for one of the residents bathrooms measured at 118 Degrees F. An outdoor seating area was observed operational for residents in care. Continued on LIC 809C Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): LIC 308 Designation of Facility Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly LIC 9020 Register of Facility Clients/Residents LIC 9282 Infection Control Copy of current Liability Insurance Copy of current Administrator Certificate Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 01/20/2026 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed. No deficiencies issued during this inspection. An exit interview was conducted with the AD A copy of this report was given to AD whose signature on this form confirms receipt of these reports.the state’s words, verbatim · CDSS document, Jan 6, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) M. Vega arrived at the facility unannounced to conduct a required annual visit at 1:00 pm and met with Administrator - Keghouhy Handian explained the reason for the visit. Entrance interview conducted. Census of 5 residents with capacity of 6. Beginning at 1:10pm, the LPA, along with the Administrator - Keghouhy Handian toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: The Kitchen and Dining area were clean and sanitary and in good repair. All pathways observed were free of obstruction and hazards. Knifes and sharp objects were locked in drawer and inaccessible to residents. The refrigerator and freezer were within operating temperature, 43 F and 0 F. They are also clean and sanitary with no spoiled food. There were at least 2 days of perishable food and 7 days of non-perishable food stored. Fire extinguishers are fully charged and were last serviced 06/24//24. Hardwired smoke and carbon monoxide detectors and fire doors were tested and operational and all were functional at the time of the visit. LPA observed exit alarms by all doors which were functional and operating. At about 2:20pm walked though residents rooms, observed All bedrooms had the required furnishing: Lamps, Chairs, a Bed, and storage for clients' clothing. All bedrooms were sanitarily clean and free from trip hazards. Report Continued on LIC 809-C All bedrooms were in good repair. Medications are locked in a closet located near the hallway. Cleaning supplies are stored in a locked cabinet in the laundry room. At about 4:30pm the bathroom water temperature was tested for one of the residents bathrooms. An outdoor seating area was observed operational for residents in care. LPA reviewed Staff and Resident files. Resident files observed to have updated information. No deficiencies were observed and cited. Exit interview conducted. Report was signed and copy of this report was provided for facility records.the state’s words, verbatim · CDSS document, Jan 21, 2025

Allegation investigated: Facility did not issue a refund to resident's responsible party.

On 4/02/2024, Licensing Program Analyst (LPA) V. Gorban visited the facility to deliver findings. During this visit LPA met with facility administrator and stated the purpose of the visit. During this visit LPA toured the facility inside and out and observed residents in care. Once the tour was complete, LPA discussed the findings with the AD. Allegation: Facility did not issue a refund to resident's responsible party. Based off of Administrator interview and file review R1 was not refunded payment of $1,324.82 for the month of January R1 when R1 contract terminated in December. Based on LPAs observations and interviews which were conducted with administrator and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulation is being cited on the attached LIC9099-D Exit interview conducted, report signed and with appeal rights provided to Administrator. Substantiatedthe state’s words, verbatim · CDSS document, Apr 2, 2024 · control 24-AS-20240229140618

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652 · Plan of correction due date: Apr 15, 2024

1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds. This requirement was not met as evidenced by LPA. Facility failed to provide refund upon resident's death with in 15 days. Responsible party was charged additional $1,324.82 for whole month of January stay when resident passed away in December. This is poses a potential health and safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 2, 2024

Plan of correction: Administrator will review and update Admission agreement and submit a copy to licensing for review. Staff will complete training on regulations and provide copy to LPA by email by POC due date.

Type of visit: Prelicensing

On 10/03/23, Licensing Program Analyst (LPA) V Gorban conducted an unannounced Pre-licensing visit. LPA met with Licensee, Keghouhy Handian, certification number 6018226740, expiration date 07/30/2024 and discussed the purpose of the visit. LPA began the tour at the entrance of the facility that has one entrance point. LPA toured the inside and outside of the facility. LPA observed no obstruction to emergency exit from back yard of the facility on west sides. The facility was observed at a comfortable temperature of 78 degrees Fahrenheit, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Common areas furnished and well-lit throughout. LPA observed the kitchen to be absent of any trash or debris, sharp objects are secured and inaccessible to residents. A two-day supply of perishable and seven-day supply of non-perishable food were observed. Medications and chemicals were kept locked in separate cabinets. Resident’s all four individual bedrooms were observed to be furnished with bed, dresser, night stand, and overhead lightning. Mattresses, box springs, sheets, and linens, were absent of any tears and stains. Bathrooms and showers were equipped with non-skid mats and securely fastened grab bars. Bathroom water temperature was tested at 105 degrees Fahrenheit. Towels, linens, and personal hygiene supplies were observed in storage. There are no bodies of water outside. All Fire extinguishers are current with service date of 04/17/2023. Carbon monoxide and smoke detectors were observed to be operational. First Aid Kit was checked and observed to have the required supplies. Emergency exit plan, required phone numbers, and required postings were observed. A working facility telephone number (559-449-1249) was present and functional. Email: gmcarehome@aol.com Component III was reviewed with Licensee and Administrator. No deficiencies were observed on this visit. Report will be submitted Centralize Application Bureau for record and further processing of application.the state’s words, verbatim · CDSS document, Oct 3, 2023