Sonlema

Allegation investigated: Lack of supervision resulted in residents eloping. Staff cannot properly communicate due to language barrier.

At 9:45 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced initial complaint visit to this facility. LPA met with staff #1 (S1) Liana Babaian and Staff #2 (S2) Anna Bumiatyan who granted access to the facility. The staff contacted the Administrator Designee via phone and LPA explained the reason for the visit. The Administrator Designee arrived shortly after. At 9:50 AM, LPA requested resident and staff roster. At approximately 9:55 AM, LPA conducted a physical plant tour of the facility. At 10:00 AM, LPA requested copies of pertinent information which include, but not limited to Staff training, Physician Report, Admission Agreement, Appraisal Needs and Services Plan, and ect., relevant to the course of investigation. Between 10:15 AM –12:30 PM, LPA conducted an interview with the Administrator Designee, two (2) Staff, and four (4) out of six (6) residents who were available. Continue on LIC 9099C Unsubstantiated Allegation: Lack of supervision resulted in residents eloping. It was alleged that lack of supervision resulted in residents eloping from the facility on 06/20/2026. To investigate this allegation, LPA conducted interviews with the Administrator Designee, two (2) staff members (S1 and S2), and four (4) out of six (6) residents who were available. Interviews with the Administrator Designee and S1, who was identified as the staff working on June 20, 2026, denied the allegation and stated that no residents left the facility on that date, no residents were observed wandering in the street, and no incident was reported. S1 stated residents are supervised throughout the day, hourly headcounts are conducted, and staff have received training on elopement prevention. Furthermore, interviews with four (4) out of six (6) residents revealed they had no knowledge of any residents leaving the facility on June 20, 2026. The Administrator Designee informed LPA that the facility is equipped with a surveillance camera system and that surveillance footage would be reviewed if an incident were reported. Because no incident was reported to the facility on June 20, 2026, surveillance footage was not reviewed. Based on staff and resident interviews, LPA was unable to obtain sufficient evidence that residents eloped or were unsupervised on June 20, 2026. Therefore, the allegation is Unsubstantiated. Allegation: Staff cannot properly communicate due to a language barrier. It was alleged that staff members have difficulty communicating with residents due to a language barrier. To investigate this allegation, LPA conducted interviews with the Administrator Designee, two (2) staff members (S1 and S2), and four (4) out of six (6) residents who were available. Interviews with the Administrator Designee and S2 confirmed that S1 has limited English proficiency and utilizes a translation application or receives assistance from S2 when needed. During today's visit, LPA observed that S1 required assistance from S2 to interpret portions of the interview. Furthermore, interviews with four (4) out of six (6) residents revealed they had no difficulty communicating with staff. Although LPA observed that S1 has limited English proficiency and uses translation assistance, resident interviews did not support that the language barrier prevented staff from meeting residents' basic needs or providing adequate care and supervision. Based on interviews and LPA's observations, LPA was unable to obtain sufficient evidence to support the allegation. Therefore, the allegation is Unsubstantiated. Appeal rights explained and exit interview conducted. Copy this report signed and delivered.the state’s words, verbatim · CDSS document, Jun 29, 2026 · control 31-AS-20260624143205

Type of visit: Case Management - Deficiencies

At 9:00 a.m., Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced visit to the facility in conjunction with Complaint Control #31-AS-20260624143205. LPA met with Staff #1 (S1) Liana Babaian and Staff #2 (S2) Anna Bumiatyan, who granted access to the facility. The staff contacted the Administrator Designee by telephone, and LPA explained the purpose of the visit. The Administrator Designee arrived shortly thereafter. During the physical plant tour, LPA observed that four (4) out of six (6) resident bedrooms did not contain chairs as required. During an interview with Resident #3 (R3), LPA observed visible scratches/marks on the right side of R3’s neck. The Administrator Designee stated that R3 exhibits self-injurious behaviors. The Administrator Designee further stated that the self-injurious incident occurred on 06/17/2026; however, no incident report was submitted to the Community Care Licensing Division (CCLD) regarding this occurrence. Deficiencies were issued and appeal rights were explained. An exit interview was conducted, and a copy of this report was signed and delivered.the state’s words, verbatim · CDSS document, Jun 29, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR87307(a)(3)(B) · Plan of correction due date: Jul 6, 2026

87307 Personal Accommodations and Services (a)...The following provisions shall apply: (3) ...the licensee shall assure:(B) Bedroom furniture, which shall include, for each resident, a chair, ...This requirement is not met as evidenced by: Based on LPA observation administrator did not ensure four (4) out of six (6) residents bedrooms contain a chair as required which poses a potential Health, Safety, or Personal rights risk for persons in care.the state’s words, verbatim · CDSS document, Jun 29, 2026

Plan of correction: Administrator agrees to properly furnish residents bedroom to be compliant with regulations. Administrator agrees to purchase a better quality chairs to prevent from breaking. Administrator will submit pictures to the department by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)A,B&D · Plan of correction due date: Jul 6, 2026

Requirements (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person... ... any of the events specified in (A), (B) & (D)... This requirement is not met as evidenced by: Based on interviews and LPA's observation, the licensee failed to submit a required incident report to CCLD regarding R3’s self-injurious behavior on 06/17/2026, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jun 29, 2026

Plan of correction: Licensee shall ensure a written report is submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of any of the events. R1's incident report shall be submitted to LPA by POC date.

Type of visit: Required - 1 Year

At 9:10 AM, Licensing Program Analyst (LPA), Huma Rahimi conducted an unannounced required annual inspection and met with the staff Liana Babaian who granted access to the facility. The staff contacted the Administrator via a telephone and LPA explained the reason for the visit. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, oven, and a sink. Stove was observed in a good working condition. At 9:20 AM, LPA did not observe a seven day supply of non-perishable food and a two day supply of perishable foods. LPA observed almost empty (one cup remaining) gallon of milk, two eggs, opened and rotten fish container, two cauliflowers, and a quarter gallon of orange juice. Staff informed LPA that two residents did not have their breakfast yet. During the visit, at around 12:00 pm, LPA observed that Resident #6 (R6) requested for a glass of milk and the staff was unable to provide. Additionally, LPA observed a knife, a scissor, and staff's medication in one of the drawers in the kitchen unlocked and accessible to residents in care. LPA also observed that residents' medication were kept in the kitchen in two cabinets (upper & lower) of which the upper one was observed locked and the lower one was unlocked and accessible to residents in care. LPA observed another drawer in the kitchen where the rest of the sharps/knives were kept locked. LPA observed a Fire Extinguisher and was last purchased on 04/13/2026. Continue on LIC 809C MEDICATION ROOM: The centrally stored medication were observed in two upper and lower cabinets of the kitchen and the upper cabinet was observed locked and the lower cabinet was unlocked and accessible to residents in care. LPA observed the residents and staff files locked in a locked cabinet in the living room. BEDROOMS: There are three (3) bedrooms designated for residents use. All bedrooms are shared. LPA observed that all bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and were observed to be operational. Furthermore, LPA observed the emergency exit in bedroom #2 (Bedridden room) to be completely blocked by a resident bed. Additionally, LPA observed resident medication to be unlocked to residents in bedroom #2 (bedridden). LPA observed Resident #1 (R1) with half bedrail and LPA asked the Administrator if there is a physician order and the Administrator stated that he did not know that he was supposed to have it. The facility has an awake staff. BATHROOMS: There are three (3) bathrooms at the facility of which two are for residents' use and one for staff use. LPA observed the staff bathroom unlocked and accessible to residents in care with clorox on the top of the toilet tank, drain clog remover, disinfectant spray next to the toilet. LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and had non-skid mat The water temperature was noted at 112.5°. In one of the residents' bathroom, LPA observed under the sink cabinet to have a Clorox gallon and Awesome Bleach gallon and was observed unlocked and accessible to residents in care. Additionally, LPA observed A+D treat & heal cream in the bathroom drawer unlocked and accessible to residents in care. LAUNDRY ROOM: The laundry room is located in the kitchen and all cleaning supplies and laundry detergents were observed tol be locked in standing closet by the laundry machines inaccessible to residents in care. The washer/dryer appear to be in good working condition. Continue on LIC 809C COMMON AREAS: The facility maintains a comfortable temperature at 73°F. The living room and dining area appeared clean and were properly furnished and has a television. Additionally, self-closing fire door was altered by taking out the door handle and was plastered completely and placed a air freshener spray in the middle of the door to prevent from closing during the emergency. The Administrator stated that he did not know and LPA explained the reason why the fire door is not supposed to be blocked or altered. No any other obstructions and or tripping hazards throughout the facility. LPA observed a working telephone for the facility. SURROUNDING GROUNDS: The facility has sufficient backyard space. LPA did observe appropriate outdoor furniture in the backyard of the facility that can accommodate six (6) residents, LPA observe a covered shaded area for residents. There is no swimming pool or any bodies of water at the facility. The exit was free of any obstruction or hazard. Garage/Storage: The facility does not have an extra space or a garage. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 9:35 AM, they were tested and observed to be operational. Between 11:30 AM to 1:15 PM, LPA reviewed records of six (6) residents and three (3) staff. LPA observed that Resident #1's (R1's) records were missing a TB test results and consent forms, Resident #2 (R2) records had a partially completed Appraisal Needs and Services Plan (LIC 625), Resident #3 (R3) records were missing a Physician report, TB test results, consent forms, and LIC 625, Resident #5 (R5) records were missing LIC 625 and TB test results, and Resident #6 (R6) records were missing ID information, consent forms, and LIC 625. During the staff file review, LPA observed that Staff #1 (S1) records were missing 1st Aid and CPR training, and in-service training. Staff #2 (S2) records were missing TB test results, 1st Aid and CPR training, in-service training and health screening form (LIC 503). Upon LPA's request for the Administrator facility file, the Administrator asked LPA if the Administrator is also supposed to have a facility file available for review. During the visit, LPA observed that the Administrator lacked knowledge of the title 22 regulations and rules and stated that he did not know. Administrative: LPA collected LIC500. Deficiencies issued during today's visit. Appeal rights explained. Exit interview conducted and copy this report signed and delivered.the state’s words, verbatim · CDSS document, Apr 13, 2026

Allegation investigated: Staff neglect resulted in a resident to sustain pressure injuries while in care. Staff are not able to properly position a resident while in care. Staff do not have the appropriate equipment to move a resident. Staff do not have an appropriate sleeping arrangement for a resident. Staff do not communicate effectively.

At 9:30 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced subsequent complaint visit to this facility. LPA met with staff #1 (S1) Liana Babaian who granted access to the facility. The staff contacted the Administrator via phone and LPA exlained the reason for the visit. The Administrator Designee arrived shortly after. The Administrator had to leave and designated Levon Torsyan (S2) to sign today's report. An initial complaint visit was conducted on 05/23/2025 and a subsequent visit was conducted on 06/16/2025. At 11:05 AM, LPA requested resident and staff roster. At approximately 11:10 AM, LPA conducted a physical plant tour of the facility. At 11:15 AM, LPA requested documents; however, no documents were provided upon request. Between 11:20 AM – 12:20 PM, LPA interviewed the Administrator Designee, Staff #2 (S2), and one (1) out of one (1) resident. During the subsequent visit on 06/16/25, LPA conducted additonal interviews with the Administrator Designee and staff #2 (S2). During today's visit, LPA conducted an interivew with one (1) out of six (6) residents who were avaliable. Continue on LIC 9099C Substantiated Staff neglect resulted in a resident sustaining pressure injuries while in care. It was alleged that Resident 1 (R1) was observed with untreated wounds on their backside. To investigate this allegation LPA conducted an interview with Administrator Designee and S2 and LPA was informed that R1 was admitted to the facility on 05/15/2025 and hospitalized on 05/20/2025. LPA was informed that the Administrator failed to complete a proper assessment of R1’s condition upon admission to ensure appropriate wound care services were in place. Furthermore, LPA was informed that S2 observed R1 with a wound on R1's backside during R1's stay at the facility. On 05/17/2025, S2 received a call from a Home Health nurse notifying the facility of R1’s wound assessment appointment. LPA reviewed Home Health records and it was confirmed that R1 was assessed by Lifespring Home Health on 05/17/2025 for wound care. R1 received the first documented wound treatment on 05/20/202. Lastly, On 05/30/2025, LPA reviewed hospital medical records, which documented that R1 was evaluated with a Stage II pressure injury on the left gluteal area. Based on interviews and record reviews, the facility failed to conduct a proper assessment of R1’s wound condition upon admission and failed to ensure consistent wound care services were provided. Therefore, the allegation is Substantiated. Staff are not able to properly position a resident while in care. It was alleged that R1 remained in a wheelchair for four (4) days and staff were unable to reposition R1. To investigate this allegation LPA conducted an interview with the Administrator Designee and S2 and both confirmed that staff were unable to move R1 due to R1’s weight (300 lbs.). Furthermore, LPA was informed that the staff only moved R1 for incontinent/diaper changing purposes. Lastly, LPA requested staff training documentation, but the facility was unable to provide evidence of proper training to meet R1’s care needs. Based on interviews and record review, the allegation is Substantiated. Staff do not have the appropriate equipment to move a resident. It was alleged R1 was not moved for four (4) days due to lack of personnel and equipment. To investigate this allegation LPA conducted interviews with the Administrator Designee and S2, and both confirmed that the staff were unable to move R1 because the facility did not have a Hoyer lift during R1’s stay from 05/15/2025 to 05/20/2025. Furthermore, R1 was not properly assessed prior to admission, and the Administrator failed to order the necessary equipment in advance. As a result, on 05/20/2025, R1 attempted to stand, fell, and remained on the floor until paramedics arrived. Continue on LIC 9099C Lastly, LPA reviewed an invoice of Hoyer lift which was ordered on 05/18/2025 but arrived after R1’s hospitalization. Based on interviews and record review, the allegation is Substantiated. Staff do not have an appropriate sleeping arrangement for a resident. It is alleged that R1 was confined to a chair for four (4) days and had difficulty sleeping. It is also reported that R1 only has been in bed for total of three (3) hours over the last four (4) days. To investigate this allegation LPA conducted an interview with the Administrator Designee and S2 and both admitted that R1 did sleep in their wheelchair from 05/17/2025 to 05/20/2025 and only was in their bed for three (3) hours before their hospitalization on 05/20/2025. Furthermore, LPA was informed that due to R1’s weight (300LB) the facility staff were unable to move R1 from and to bed daily; and therefore, R1 decided to remain/sleep in the wheelchair. Both parties interviewed also confirmed that due to the lack of proper assessment the facility also did not have sufficient equipment to provide proper arrangements for sleeping. Therefore, based on interviews this allegation is deemed Substantiated. Staff do not communicate effectively. It was alleged that staff members have difficulty communicating with residents due to a language barrier. To investigate this allegation LPA conducted an interview with the Administrator Designee and S2. Both parties interviewed confirmed that Staff #1 (S1) has difficulty communicating in English with residents, the majority of whom speak English. Furthermore, during initial visit on 05/23/2025, LPA conducted an interview with one (1) out of one (1) resident, and during today’s visit LPA conducted an interview with one (1) out of six (6) residents who were available. Interview with residents stated that they have trouble communicating with S1 for basic needs. Lastly, during initial, subsequent, and today’s visit LPA observed that S1 is using a translator application on their phone to communicate with LPA and is unable to communicate in English, and during all visits, LPA also observed that S1 is the only staff available at the facility to provide care and supervision to residents in care. Based on staff and resident interviews, and LPA’s direct observation, the facility failed to ensure effective communication between staff and residents. Therefore, the allegation is Substantiated. Deficiencies cite and appeal rights explained. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Oct 2, 2025 · control 31-AS-20250522152714

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(d)(3) · Plan of correction due date: Oct 9, 2025

87411-Personnel Requirements General-(d)(3)Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents.,.This requirement is not met as evidenced by: Based on LPA’s interview and observation, the administrator does not have staff available to communicate with residents to provide care which poses a potential risk to the residents in care.the state’s words, verbatim · CDSS document, Oct 2, 2025

Plan of correction: Administrator agreed to update LIC 500 with an additional staff (S1 or Administrator) who can communicate effectily in English to meet residents needs at all times. Updated LIC 500 will be submitted to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(a) · Plan of correction due date: Oct 9, 2025

87457 – Pre-Admission Appraisal (a) Prior to acceptance of a resident, the licensee shall obtain and evaluate a written medical assessment of the prospective resident to ensure the facility can meet the resident’s needs Based on interviews and record reviews the Licensee did not comply with the section cited above by failing to obtain proper pre-admision appraisal prior to R1s admission to the facility which posed a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 2, 2025

Plan of correction: Administrator will immediately review and revise the pre-admission appraisal process to ensure all medical conditions, including wounds, are accurately assessed before admission. 2. Staff will be trained on wound care protocols, including timely referrals, documentation requirements, and monitoring of outside providers’ recommendations. Proof of staff training will be submitted to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87459(a)(4) · Plan of correction due date: Oct 9, 2025

87459-Functional Capabilities (a)The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform.... :(4) Transferring, including the need for assistance in moving in and out of a bed or chair. This requirement is not met as evidenced by: Based on interviews and record reviews the Licensee did not comply with the section cited by leaving R1 on a wheelchair for four (4) days without transferring to bed and not providing proper equipment (Hoyer lift) to R1 which poses a potential risk to the residents in care.the state’s words, verbatim · CDSS document, Oct 2, 2025

Plan of correction: Administrator agreed to provide proper equipment (Hoyer lifts, bariatric chairs/beds) to residents prior to admitting them to the facility. 2. Administrator also agreed to provide training to all staff for safe transfer techniques using mechanical lifts Proper positioning to prevent falls, and discomfort. Training records will be maintained and submitted to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Oct 9, 2025

87468.2-Additional Personal Rights of Residents in Privately Operated Facilities(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, ...... personal rights:(4) To care, supervision, and services....This requirement is not met as evidenced by: Based on interviews and record reviews the Licensee did not comply with the section cited above by leaving R1 in a wheelchair for (4) days without repositing/moving which posed a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 2, 2025

Plan of correction: Administrator agreed to ensure staff receive immediate training on safe resident positioning, transfers, and the use of assistive devices for residents requiring mobility support. The proof will be submitted to LPA by POC due date.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Huma Rahimi, conducted unannounced case management visit - incident to this facility and met with Levon Torosyan (Administrator Designee) and Staff #1 (S1) Liana Babaian. S1 contacted the Administrator via telephone and LPA was informed that he cannot come; however, designated Levon Torosyan to sign today's report. On 07/26/2025, LPA received LIC 624 (incident report) via e-mail from the Administrator regarding Resident #1 (R1) elopement from the facility. During today's visit, LPA conducted an interview with the designee and S1 and LPA was informed that on 07/26/2025, at around 7:30 AM, R1 woke up with a very aggressive behavior. The designee and S1 were both present at the facility and contacted the Administrator informing about R1's behavior. Both the designee and staff were advised to observe R1 closely. The designee observed that R1 was pacing in the facility inside and out holding an iPad. R1 came inside and smashed the iPad on the ground. The designee provided morning medication to R1 hoping R1 will calm down. At around 8:30 AM, R1 demanded to go for a walk and the designee agreed to take R1 for a walk in the front yard area of the facility. R1 pushed away the designee aggressively who fall down on the ground resulting an injury to his left hand. R1 was able to open the facility's main exit and elope from the facility. The designee followed R1; however, due to the injury to his left hand the designee was unable to locate R1. At 8:40 AM, the designee immediately informed the Administrator and 9-1-1 was contacted. Up to date, R1 did not return to the facility. The facility followed all the appropriate protocols to prevent R1's elopement; and therefore, no deficiencies will be issued. Continue on LIC 809C Other: On 05/23/2025, LPA conducted an unannounced case management visit and issued a deficiency and a civil penalty for Administrator qualification. The deficiency stays in effect; however, the civil penalty was issued inadvertently and during today's visit will be rescinded. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jul 29, 2025

Type of visit: Office

Licensing Program Manager (LPM) Nichelle Gillyard and Licensing Program Analyst (LPA) Huma Rahimi met with Hovik Odabashyan to conducted an Informal Conference held at the Woodland Hills South Adult and Senior Care Regional Office. The purpose of the informal was to discuss recent deficiencies. LPM made introductions and verified the current administrator information, facility phone number and email. LPM reviewed and discussed LIC500 Personnel report and staffing. The LIC500(Personnel Report) dated 06-17-2025 shows that the Administrator is scheduled to be at the facility M-F from 6pm-8 pm. There are 2 caregivers, one scheduled from 8am-8pm and the other 8 pm to 8 am, Monday -Sunday. The current census is 5. Sonlema Inc. was first licensed 03-12-2025 and since being licensed the licensee has been cited for many deficiencies that are of concern and need to be addressed. On July 07, 2025, the department received a complaint with three (3) allegations. July 16, 2025, LPA Rahimi, conducted the complaint investigation and substantiated the complaint for: Staff allowed resident in care to leave the facility unassisted Staff did not provide medication assistance to residents in care. Staff cannot properly communicate with residents in care. Continue on LIC 809C The following deficiencies were issued: 1. Personnel Requirements 2. Incidental Medical and Dental Care 3. Basic Services On May 23, 2025, LPA conducted a case management visit. The following deficiencies were issue: 1. Criminal Record Clearance- Two staff not associated and Administrator designee was not fingerprint cleared and associated. 2. Administrator qualifications- The Administrator lacked knowledge of the appropriate care of a resident. Moreover, the facility currently has a pending complaint investigation which was received on May 22, 2025. The following allegations were discussed during the visit: Staff neglect resulted in a resident sustain pressure injuries while in care. Staff are not able to properly position a resident while in care. Staff do not have the appropriate equipment to move a resident. Staff do not have an appropriate sleeping arrangement for a resident. Staff do not communicate effectively.” During the meeting LPM discussed the Technical Support Program (TSP) with the Administrator. Other: LPM discussed the reporting requirement, and civil penalties were discussed. LPM also provided Health and Safety Code (HSC) regulations regarding Medication and Staff Training to the Administrator. Administrative submit liability insurance and an updated LIC 500 (Staff Roster) to include more staff based on the needs of the residents. LPM discussed age exceptions. The request have already been received for two (2) residents under the age of sixty (60). LPM discussed the administrative process. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 23, 2025

Allegation investigated: Staff allowed resident in care to leave the facility unassisted. Staff did not provide medication assistance to resident in care. Staff cannot properly communicate with residents in care.

At 9:10 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced initial complaint visit to this facility. LPA met with a staff Liana Babaian who granted access to the facility. The staff contacted the Administrator and Staff #2 (S2) Levon Torosyan via phone and LPA explained the reason for the visit. The Administrator and S2 arrived at 9:37 AM. The Administrator had to leave and designated S2 to sign today's report. At 9:38 AM, LPA requested resident and staff roster. At approximately 9:40 AM, LPA conducted a physical plant tour of the facility. At 9:50 AM, LPA requested copies of pertinent information which include, but not limited to Staff training, Physician Report, Admission Agreement, Appraisal Needs and Services Plan, Centrally Stored Medication and Destruction Record (CSMDR), and ect., relevant to the course of investigation. Between 10:20 AM – 2:30 PM, LPA conducted an interview with the Administrator, Staff #1 (S1), Staff #2 (S2), and three (3) out of five (5) residents who were available. Continue on LIC 9099C Substantiated Staff allowed resident in care to leave the facility unassisted. It is alleged that due to facility staff neglect Resident #1 (R1) eloped the facility unassisted. To investigate this allegation LPA reviewed R1's Physician report and was revealed that R1 cannot leave the facility unassisted or unsupervised. Furthermore, LPA conducted an interview with Administrator and S2 and both confirmed that R1 eloped the facility without staff knowledge on 07/05/2025 at around 8:30 AM. Therefore, based on the record review and information gathered through interviews this allegation is deemed Substantiated. Staff did not provide medication assistance to resident in care. It is alleged that the facility staff does not provide R1's medication properly. To investigate this allegation LPA conducted an interview with the Administrator who denied the allegation and informed LPA that they always provide medication to all the residents in a timely manner without any discrepancy. However, review of R1's medication revealed that the facility was supposed to start R1's prescribed medication Fluoxetine HCL (mental health condition medication) on 06/27/2025. LPA counted R1's medication and it was discovered that five (5) pills were missing from the Fluoxetine HCL bottle. Additionally, LPA reviewed other four (4) prescribed medication of R1's and they were observed to have discrepancies as well. LPA asked the Administrator and the staff for explaining and both staff could not provide any answers. Therefore, based on the medication record review, interviews, and observation this allegation is deemed Substantiated. Staff cannot properly communicate with residents in care. It was alleged that the facility staff do not speak English and is hard to communicate with residents in care. To investigate this allegation LPA conducted an interview with the Administrator who admitted that S1 does not speak English; however, uses an application through their personal cellular telephone to communicate with the residents in care for their basic needs. Furthermore, LPA conducted an interview and concluded that one (1) out of one (1) staff was not able to communicate in English with the residents of which the majority speak English. Moreover, interviews with three (3) out of five (5) residents confirmed that they have trouble communicating with staff for their basic needs. Lastly, during todays visit LPA used Focus Language International Inc Telephone-Based Interpreter service to conduct an interview with S1 due to language barrier. Based on interviews and LPA's observation this allegation is deemed Substantiated. Deficiencies issued and appeal rights explained and given. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jul 16, 2025 · control 31-AS-20250707124845

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(d)(3) · Plan of correction due date: Jul 23, 2025

87411-Personnel Requirements - General(d) All personnel shall be given on the job training or have........effective job performance:(3) Skill and knowledge required to..care and supervision, including the ability to communicate with residents. This was not met as evidence by: Based on the interview, the administrator did not have staff available to communicat in English with residents in care which poses a potential risk to the residents in care.the state’s words, verbatim · CDSS document, Jul 16, 2025

Plan of correction: Administrator agrees to put in writing their plan for hiring or ensuring English Speaking staff are always on shift and submit the plan by the POC date. Additionally, Administrator shall submit an updated LIC500 to reflect all staff.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: Jul 18, 2025

87465- Incidental Medical and Dental Care: c) If the resident's physician has stated in writing... 2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Based on observation, interview, record review, the licensee did not comply with the section cited above in not assuring that R1's prescribed medications were given as prescribed, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 16, 2025

Plan of correction: Administrator agreed to schedule vendorized training for all staff by 07/18/25 and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion. LIC 624 will be submitted to LPA.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jul 18, 2025

87464(f)(1) Basic ServicesBasic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Interviews with the Administrator, staff, and file reviews. Lack of staff supervision resulting in the elopement of residents in care. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 16, 2025

Plan of correction: The Adminstrator has agreed to the following:1. Update the appraisal Needs and service plans and reappraisal to address the elopements. 2. Train all staff on the newly updated care plans regarding the elopements attach a sign in sheet.3. Submit to CCL.

Type of visit: Case Management - Deficiencies

At 9:30 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20250522152714. LPA met staff #1 (S1) Gayane Kirakosyan who was present at the facility at the time of the visit and granted access to facility. Staff #2 (S2) Levon Torosyan arrived later at the facility and contacted the Administrator. The Administrator refused to come to the facility and informed LPA that a designee will come to the facility. LPA explained the reason for the visit to the Administrator. At 11:00 AM, the designee Hovik Odabashyan, arrived and LPA explained the reason for the visit to the designee. During the visit, LPA was informed that S1 has been working at the facility as of 05/19/25 and occasionally comes and helps with the facility and S2 is working on a regular shift Monday through Friday from 7:00 AM through 7:00 PM as of 03/12/2025; however, both staff are not fingerprint cleared or associated to the facility. Furthermore, the assigned designee who arrived at the facility also was not associated to the facility and denied any future association to the facility. Additionally, interview with one (1) out of one (1) resident confirmed that both staff are working on daily basis at the facility since the time of their admission as of 05/18/2025. Moreover, LPA reviewed LIS and did not observe S1, S2 fingerprint cleared or associated to the facility. LPA observed that the designee is being fingerprint cleared; however, not associated with the facility. LPA also observed that the Administrator lacks qualification by not demonstrating the requirements for appropriate care and supervision of the residents in care. During the course of investigating complaint # 31-AS-20250522152714, the facility also did not have any records for Resident #1 (R1) and Resident #2 (R2) at the facility. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D. Exit interview conducted, appeal rights explained and copy of report signed and delivered.the state’s words, verbatim · CDSS document, May 23, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: May 26, 2025

Criminal record clearance: (e) All individuals subject to a criminal record review... (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, and LIS personnel record review the licensee did not comply with the section cited above by hiring two (2) staff members without fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 23, 2025

Plan of correction: Licensee agreed to complete S1's and S2's fingerprints and associate both staff to the facility. Copy of proof will be submitted to LPA by POC date. Civil penalty assessed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(2) · Plan of correction due date: May 26, 2025

87355(e)(2) Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline. This requriement is not met as evidenced by: Based on interview, and LIS personnel record review the licensee did not comply with the section cited above by not associating the Administrator designee to the facility since 05/19/2025, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 23, 2025

Plan of correction: The administrator shall associate the Administrator Designee immediately. Administrator shall submit proof to LPA that association was completed immediately. Civil penalty assessed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: May 30, 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 #1 and Resident #2 which posed a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, May 23, 2025

Plan of correction: Administrator designee agreed to provide complete file/record for two (2) out of two (2) residents by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(d)(1,2) · Plan of correction due date: May 26, 2025

Administrator Qualifications - 87405 (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator... (1) Knowledge of the requirements... This requirement is not met as evidenced by: Based on interviews, and LPA's observation the licensee failed to ensure to demonstrate knowledge and requirement for approperiate care and supervison of the residents which poses an immediate health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, May 23, 2025

Plan of correction: The Administrator agrees to follow proper guidelines for Administrator Qualifications. LPA discussed with the Administrators’ section 87405. The Administrator agrees to submit a written letter to CCL indicating that they have read the regulations, have full understanding Civil penalty assessed.

Type of visit: Prelicensing

At 10:00 AM, Licensing Program Analyst (LPA), Huma Rahimi conducted an announced Pre-Licensing visit to the above facility and met with Sonya Milkumyan, the Licensee, and Vram Hakobyan the Administrator and explained the reason for the visit. At the time of this visit LPA did not observe any residents present in the facility. Fire Clearance dated 10/31/2024 and received for six (6) Non-ambulatory residents of which one is Bedridden in bedroom #1. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. The facility is a single-story building. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, oven, and a sink. Stove was observed in a good working condition. At 10:05 AM, LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. LPA observed a Fire Extinguisher and was last purchased on 10/15/2024. It was observed handing on the wall in the kitchen by the dinning table. MEDICATION ROOM: The centrally stored medication will be kept in the in the locked kitchen cabinet. Clients and staff files will be kept locked in the living room inaccessible to residents. BEDROOMS: There are three (3) bedrooms designated for residents use. All bedrooms are shared. LPA observed that all bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. The facility will have an awake staff Continue on LIC 809C BATHROOMS: There are three (3) bathrooms at the facility. LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and had non-skid mat The water temperature was noted at 109.2°. LAUNDRY ROOM: The laundry room is located in the kitchen and all cleaning supplies and laundry detergents will be kept locked in standing closet by the laundry machines inaccessible to residents in care. The washer/dryer appear to be in good working condition. COMMON AREAS: The facility maintains a comfortable temperature at 68°F. The living room and dining area appeared clean and were properly furnished and has a television. No obstructions and or tripping hazards throughout the facility. LPA observed a working telephone for the facility. SURROUNDING GROUNDS: The facility has sufficient backyard space. LPA did observe appropriate outdoor furniture in the backyard of the facility that can accommodate six (6) residents, LPA observe a covered shaded area for residents. There is no swimming pool or any bodies of water at the facility. The exit was free of any obstruction or hazard. Garage/Storage: The facility does not have an extra space or a garage. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 10:20 AM, they were tested and observed to be operational. Component III was conducted with the Licensee/Administrator. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and be notified by the CAB Analyst when your license has been approved. Exit interview was conducted and with a copy of this report was provided to the Applicant/Administrator.the state’s words, verbatim · CDSS document, Feb 24, 2025

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Dec 6, 2024