Three C's Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility to conduct a required annual visit. Upon arrival LPA met with staff Ani Palezyan and reason for the visit was explained. LPA was informed that currently the facility is under change of ownership and an application was submitted by Ani Palezyan and Sergey Karapetyan in 05/2026. The LPA toured the physical plant areas inside and outside, with staff to ensure there are no health and safety hazards. KITCHEN: All kitchen appliances observed in good repair and operable. The facility has a sufficient supply of perishable food and nonperishable food. Knives, medications, and chemicals were locked and inaccessible. The facilities laundry closet is located in the kitchen which was locked and inaccessible to residents at the time of the visit. BEDROOMS: There are (3) three bedrooms designated for resident use. The facility has furnished each room with clean linens, appropriate furnishings, and sufficient lighting for resident use. RESTROOMS: The LPA observed resident restrooms to be clean, sanitary, and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products. Restroom hot water measured between 120.9 and 115.0 degrees Fahrenheit. COMMON AREAS: The common spaces included the living room and dining area. All areas were clean, sanitary and in good repair. The LPA observed required postings on the living room wall. One fire extinguisher was observed to be fully charged and last purchased on 3/26/26. Smoke detectors and Carbon Monoxide detectors were tested and confirmed to be operable at the time of the visit. (Continue to LIC809c) BACKYARD: Detached garage is converted to a separate living space but is being used for storage and has an additional refrigerator. The backyard free of any debris or obstructions. RESIDENT RECORDS: At approximately 11am, LPA spoke with three residents; no concerns were noted. At approximately 11:45am, LPA reviewed five (5) residents' files and all were complete. Documents reviewed included, but were not limited to, physician's reports, admission agreements, personal rights, and needs and services plans. STAFF RECORDS: At approximately 12:30pm, LPA reviewed four (4) staff files and all were complete. Documents reviewed included, but were not limited to, training records, TB test results, health screenings, and fingerprint background clearance. MEDICATIONS: At approximately 1:15pm, LPA reviewed medications which are stored in the locked cabinet in the kitchen. The facility has Centrally Stored Medication and Destruction Records (CSMDR) which were complete. LPA reviewed three (3) residents medications with staff. The medications reviewed appeared to be given as prescribed and the medications were properly labeled and stored. The first aid kit was observed complete with manual. LPA reviewed facility’s policies and procedures as it pertains to infection control and emergency disaster. Both were reviewed by staff in 3/2026. Last disaster drill was conducted on 6/5/2026. LPA requested a current copy of the facility Personnel Report - LIC500 and Liability Insurance be sent to the Regional office. Staff Ani P. stated that she will send copies today. No deficiencies cited. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Jun 17, 2026

Allegation investigated: . Licensee does not ensure staff has ability to communicate with residents 2. Licensee does not ensure staff is in good physical health to perform assigned tasks

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegations and discovered that the facilty was sold and being operated by the new buyer, Ani Palezyan. Per telephone conversation with the Operator no application has been submitted to the Department for consideration and the previous owner is out of town for a family function. The new buyer was advised that they are operating unlicensed and was referred to Licensing Program Manager Kristin Heffernan. During today's visit, a health and safety check was included to ensure that there were no immediate safety concerns observed. Ani arrived at 1:27pm to conducted the visit. Also participating in today's visit was Elmira Tsaturyan, Staff. The reason for today's visit was provided again in person. During today's visit, LPA Yee conducted a tour of the three bedrooms, 2 residents were observed in continued on LIC9099-C Unsubstantiated Page 2. bedroom #1 (front left), 1 resident in bedroom #2(back) and 1 resident in bedroom #3(front right). All four residents were visually observed to be doing well. Food supply was reviewed and utilities were observed to be in use. No visually obvious health and safety concerns were observed during the visit Interviews were conducted with Staff # 1:25pm, Ani Palezyan, New owner at 1:25pm, Staff #2 at 1:39pm. Food supply was reviewed at 1:55pm. Per information received from interviews conducted regarding, allegation #1 - Licensee does not ensure staff has ability to communicate with residents, the investigation revealed that Staff #1 does not speak English but she does not work alone. Per Ani, she and her husband are always at the facility or are in and out of the facility and are always available via telephone if translation is needed. Staff #2, who just started today, will also be working together with Staff #1, speaks and comprehends English sufficiently to understand the requests of the residents. Based on the information received from interviews conducted, there is insufficient evidence to support the allegation that the Licensee does not ensure staff has ability to communicate with residents, therefore the allegation is unsubstantiated at this time. Per interviews conducted regarding allegation #2 - Licensee does not ensure staff is in good physical health to perform assigned tasks, the staff from the previous ownership was not retained by the new operator. Per the Operator, staff do not have files at this time and no physicians reports were available for staff. Per visual observation of the current staffing, there is no seventy (70) year old staff who can barely walk and taking small steps when providing care to the residents as described in the complaint was observed working at the home. Based on the visit and interviews conducted, there is insufficient evidence to support the allegation that the Licensee does not ensure staff is in good physical health to perform assigned tasks, therefore the allegation is deemed to be unsubstantiated at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. The New Operator, Ani Palezyan, was reminded to ensure that all staff get a criminal record clearance and be associated to the facility prior to being present at the facility. Exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 27, 2026 · control 29-AS-20260422085154

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and met with Milagros Lopez, Administrator. The reason for today's visit was provided. The facility is a single storey family home consisting of a living room, dining room, kitchen, three bedrooms, a private bathroom, a common bathroom and a detached garage. The facility is fire cleared for five(5) non-ambulatory and one(1) bedridden. Bedroom #3 is designated for bedridden use. The following was observed during today's visit: The living room and dining room was furnished with the appropriate furniture for 6 residents. The kitchen was equipped with a stove, microwave, a dishwasher and a refrigerator. Also observed were various appliances such as rice cooker, air fryer and water cooler. Located inside the kitchen is the laundry closet that houses the washer and dryer. The only fire extinguisher purchased on 3/1/25 is also mounted in the kitchen. Sufficient perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days was observed on the premises. Knives and the sharps container are locked in a kitchen drawer, Medications are stored in a locked kitchen cabinet, cleansing solutions are stored in a locked cabinet under the kitchen sink. All 3 resident bedrooms was furnished with 2 beds, 2 night stands, 2 lamps, 2 folding chairs, a shared set of drawers and a built in closet. The appropriate bed linens were observed on all the beds except for the hospital bed in bedroom #3. Per the Administrator, the resident does not want a flat sheet or blanket Page 2 and prefers the comforter. Bedroom #3 also has a sliding glass door that leads to the back yard. The auditory device was not operational when tested. Located inside bedroom #3 is a private bathroom equipped with a shower stall, grab bars, a slip resistant mat, a toilet and a single sink vanity. Shampoos, deodorants and other hygiene products are stored in locked drawers. The water temperature was tested and read 106.6 degrees Fahrenheit. The common bathroom, located by bedroom #1 was equipped with a bath tub/shower, a toilet and a single sink vanity. Grab bars were observed in the shower and by the toilet. A slip resistant mat and chair was observed in the shower. The water temperature was tested and read 112.6 degrees Fahrenheit. Additional hygiene products such as toothpaste, lotions were observed in the locked cabinet under the sink. Bath towels and extra linens were observed in a cabinet above the toilet. The hardwired smoke detectors located in all 3 bedrooms, hallway, living room and kitchen were tested and were operational. The only carbon monoxide detector located on the living room wall was also tested and was operational. The auditory device on the front door was not operational The first aid kit was inspected and had the required gauzes, strips, tweezer, scissors and an external thermometer. No first aid manual was observed. All active staff have current first aid/CPR training. All inactive staff are to obtain current first aid/CPR training prior to working alone with the residents. The facility has current general liability insurance that meets the required limits of $1 million per occurrence and $3 million total annual aggregate. The backyard was observed to have a table and chairs and an umbrella for shade. The hospital bed, head and foot board, fruit picker, discarded wood needs to be thrown out or stored away. Per the Administrator, the converted garage located in the back is used for storage of supplies. It is unknown if permits were obtained for the conversion and may not be inhabited by staff or residents. Trash cans were observed to be tightly sealed. The front yard was observed with a table and 4 chairs. Deficiencies were cited under California Code of Regulations, Title 22, Division 6, Chapter 8 Exit interview was conducted, Appeals Rights discussed and a copy was provided.the state’s words, verbatim · CDSS document, Jun 16, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and met with Milagros Lopez, Administrator, The reason for today's visit was provided. The facility is a single storey family home consisting of a living room, dining room, kitchen, three bedrooms, a private bathroom, a common bathroom and a detached garage. The facility is fire cleared for five(5) non-ambulatory and one(1) bedridden. The following domains were reviewed on today's visit: Infection Control, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Planned Activities, Food Service, Incidental and Medical. 3 staff files and 6 resident files were reviewed. Due to time constraints the following domains will be reviewed on a return visit: Physical Plant/Environmental Safety, Resident Records/Incident Reports, Disaster Preparedness and Residents with Special Health Needs. Per review of the domains noted above, staff files and resident files, no deficiencies were cited on today's visit. Exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 21, 2024