Sylmar Board & Care II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan initially met staff Hasmik Gevorgyan who called the co- Administrator Andranik Ter-nersesian for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. The co Administrator designated Ms. Gevorgyan to sign the report. A tour of the physical plant was conducted at 12:32 PM and the following was noted: There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. The facility has a designated visitors' area at the front yard. The facility has sufficient stock of PPE in the storage room. The facility has four (4) bedrooms and two (2) bathrooms currently occupying six (6) residents. One (1) bathroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents, one (1) of which may be bedridden on Room #2 . Hospice waiver for four (4) residents. Living and dining room furniture were also checked. The living room is neat and clean. The facility maintains a comfortable temperature at 75°F. The smoke detectors are hardwired and interconnected and observed to be operational. There is a carbon monoxide installed at the facility. Fire extinguisher is located in the dining area and observed to be full and last bought on 10/30/25. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. (continued on LIC 809-C) (continued on LIC 809-C) There is no garage at the facility, only car port located at the front and side. There is a sitting area in the front yard for residents to conduct outdoor activities. There is a shed at the backyard being used as a storage for frozen food, PPE and other supplies. Laundry area is located at the back. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the laundry area. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was measured at 108.7°F. Towels and washcloths are not shared. There was enough clean linen available in stock at the cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. There is a complete first aid kits located in the kitchen. Client records: Client records are reviewed. Client records appear to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. Disaster drill was last conducted on 03/26/26. Required posting observed in facility (complaint hot line poster). Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Apr 5, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan initially met staff Rysbubu Kerimbekova who called the co Administrator Andranik Ter-nersesian for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. The co Administrator designated Ms. Kerimbekova to sign the report. A tour of the physical plant was conducted at 12:22 PM and the following was noted: There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. Signs to wear a mask and other Covid 19 prevention protocol signs were posted inside. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the front yard. The facility has sufficient stock of PPE in the storage room. The facility has four (4) bedrooms and two (2) bathrooms currently occupying three (3) residents. One (1) bathroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents, one (1) of which may be bedridden on Room #2 . Hospice waiver for four (4) residents. Living and dining room furniture were also checked. The living room is neat and clean. The facility maintains a comfortable temperature at 75°F. The smoke detectors are hardwired and interconnected and observed to be operational. There is a carbon monoxide installed at the facility. Fire extinguisher is located in the dining area and observed to be full and last bought on 10/03/24. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. (continued on LIC 809-C) (continued on LIC 809-C) There is no garage at the facility, only car port located at the front and side. There is a sitting area in the front yard for residents to conduct outdoor activities. There is a shed at the backyard being used as a storage for frozen food, PPE and other supplies. Laundry area is located at the back. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the laundry area. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was measured at 113.9°F. Towels and washcloths are not shared. There was enough clean linen available in stock at the cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. There is a complete first aid kits located in the kitchen. Client records: Client records are reviewed. Client records appear to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. Disaster drill was last conducted on 12/16/24. Required posting observed in facility (complaint hot line poster). Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Feb 18, 2025

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Gary Tan, Ray Come and Leizl Dela Cerra conducted an announced Pre Licensing visit to this facility and met with Licensee representative Andy Terner. The applicant is "Sylmar Board and Care II". Fire Clearance dated 02/01/24 was received for six (6) non-ambulatory residents, one (1) of which maybe bedridden on Room #2 Purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with the rules and regulations of California Code of Regulations, Title 22, Division 6. Facility is a single storey home. Today's site visit consisted of LPAs touring the physical plant at 9:22 AM inside and outside and observed the following: The facility smoke alarm system is hard wired and interconnected. The fire extinguisher is located near the dining area and was observed to be fully charged and last bought on 02/18/24. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. Alarms were tested and observed to be operational. Hot water was tested in the common bathroom and measured at 115.3°F. There is a functioning telephone on the premises. An emergency exit plan/sketch is posted on the hallway wall with other posting requirements. There are four (4) resident bedrooms, room #3 and room #4 are shared room and the rest are private rooms. Resident bedrooms were observed to be appropriately furnished. The common areas (living room, kitchen, office and dining areas) were appropriately furnished and lighting was adequate. The living room has a comfortable furniture. Residents, staff records and medications will be stored in a designated secured filing cabinet in the dining area. The first aid kit is readily available in the kitchen. There are two (2) bathrooms in the facility. The bathrooms have appropriate grab bars installed and non-skid mats. (continued to LIC 809-C) (continued from LIC 809) The kitchen knives and sharps will be stored in a locked drawer in the kitchen. Kitchen cleaning supplies are stored in a locked cabinet below the sink. Laundry detergents, cleaning supplies and other toxins are stored in a locked cabinet in the laundry area. The laundry area is located at the backyard. The necessary precautions have been made to the facility to safely house dementia residents such as auditory alarms on all doors and locked areas for centrally stored medications. Auditory alarms were tested and observed to be operational. Facility appears to be clean and in good repair. Appliances in the kitchen appeared to be functional. There will be a screening station immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks will be available. Required poster are posted all over the facility. The facility had submitted a Mitigation and Infection plan. There is a sitting area in the back and side yards for residents to conduct outdoor activities. The backyard is fenced. There is no body of water in the facility. There is a storage area beside the laundry at the backyard for PPE and other supplies. There is no garage at the facility only car ports on the side and front. Component III was waived as approved by LPM Nichelle Gillyard as the licensee has two (2) other existing facility in good standing. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. Exit interview conducted and copy of this report issuedthe state’s words, verbatim · CDSS document, Mar 8, 2024