Velvet Care

Type of visit: Case Management - Legal/Non-compliance

At 01:00 PM, Licensing Program Analyst (LPA) Leslie Ngo-Castaneda, conducted a Case Management - Legal/Non-compliance visit and inspection of the facility to ensure facility compliance. LPA met administrator, Naira Paroyan, and explained the reason for the visit. On July 31, 2026, a Non-Compliance Conference (NCC) was held at the Woodland Hills Regional Office. As a result of that NCC, the facility was placed on a one-year compliance plan. The purpose of today’s visit is to conduct thorough inspection to ensure compliance. LPA conducted a physical plant tour to ensure the health and safety of the clients and that the physical plant was in compliance with CA Title 22 Regulations at 1:23PM. At approximately 2:05 PM, LPA requested staff and resident records. LPA was informed that the facility currently has six (6) residents and two (2) staff members. During today's visit LPA observed two (2) staff members on duty. LPA also checked the Licensing Information System (LIS) and observed that staff members/ Caregivers are associated with this facility and the fingerprints are cleared. LPA interviewed all residents, and all residents confirmed they feel happy, they love the facility, and have no concerns regarding food, staff and/or the care they receive in the facility. Resident Files: At 2:05 PM LPA conducted resident and staff records review. The following was observed. Six (6) out of six (6) residents’ files were updated and complete. All required forms were present. Staff Files: The Administrator stated that the facility currently has two (2) staff members. LPA observed all files were complete and updated. Exit Interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Aug 31, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. At 11:05 AM Naira Paroyan who is the administrator met with LPA, explained the reason for the visit. At 12:04 PM, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 11:34 AM the smoke alarms were tested and are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen, hallway and living room. The charge date is 9.17.2025. During the visit the facility is at 71 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents, one (1) of which may be bedridden in room #2 and room #4 only, hospice waiver is approved for 6. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the garage. Continue to LIC 809-C Bedrooms: There were five (5) bedrooms in the facility, four (4) bedrooms are designated for residents' use and one (1) bedroom is designated for staff. Bedroom #1 and bedroom #2 are used for private, bedroom #3, bedroom #4 is shared. The bedrooms are used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Bedroom #5 that is located at the hallway for staff and is kept locked from resident access. Bathrooms: There are two and a half (2.5) bathroom designated for residents' and staff use. The bathrooms were properly supplied and has functional fixtures. Hot water temperature was measured at 113.1 degrees Fahrenheit for bathroom #1 located inside beside room #1, which is a half-bath. Bathroom #2 is beside bedroom #0.5 and is for staff use only. Bathroom #2 is across bedroom #3. Hot water temperature was measured at 105.1 degrees Fahrenheit. There was enough clean linen available in the cabinets in the hallway. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Office is located beside the dining area. Fireplace is close and non-operational. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Infection control: Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have a swimming pool or body of water. The garage attached and is used for storage and staff refrigerator. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the laundry area and is located in the garage. Continue to LIC 809-C Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. Resident records were reviewed for requirements and legibility: LPA reviewed all of the client’s files for current appraisal for the residents. Liability insurance a copy was handed to LPA. Planned activities are offered. Facility is within CA code of Regulations Title 22 or Health and Safety Code. No deficiencies were found, exit interview conducted, copy of report has been issued and discussed.the state’s words, verbatim · CDSS document, Feb 5, 2026

Allegation investigated: Staff neglect resulted in a resident sustaining multiple pressure injuries.

This is an addendum to the original report issued 02/05/2025. Due to additional information received by the department, it was concluded that additional investigation is required. Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent visit to this facility to deliver the corrected report to the facility. LPA met with facility administrator (S1) Naira Paroyan, who granted access to the facility. On 10.31.2024, the Woodland Hills South Adult and Senior Care Regional Office received a complaint regarding the allegation, “Staff neglect resulted in a resident sustaining multiple pressure injuries.” Initial investigation was conducted by the LPA Ngo-Castaneda on 11/01/2024. During the initial investigation, at 9:40AM, LPA requested copies of pertinent information which include, but not limited to Physician’s Continue to LIC 9099-C Substantiated report, Admission Agreement, Staff Training, LIC 500, LIC 9020, hospice records, needs and service plan, discussion of hospice care plan, and relevant documents to the investigation. In addition, at 10:26 AM LPA spoke with the Administrator and other staff. At (time) LPA interview with five (05) out of six (06) residents. On 11.5.2024, LPA requested R1’s medical records from the hospital. In addition, on 9.16.2025 LPA requested and received hospice records. During this investigation R1 was no longer present at the facility. Other Residents interviewed during investigation did not address any concerns regarding their care at the facility. Staff interview revealed that staff assisted R1 with all activities of daily living. They stated that they were not assisting R1 with the wound care. Staff were relying on hospice nurses to provide assistance with wound care. A review of hospice records revealed that between January 2023 and October 2024. on and off R1 developed unstageable, stage 3 and 4 pressure injuries Per hospice records on 10.07.2024 R1 had unstageable pressure injury on Sacro-Coccyx area and left (L) heel. Hospital records revealed R1 was admitted to the hospital on 10.28.2024, at which time R1 was presented with unstageable, Stage 3 and Stage 4 pressure injuries. Based on inspection, observation, interviews and record review, facility admitted and retained a resident with prohibited health condition unstageable, Stage 3 and 4 pressure injurie, and staff at the facility failed to provide appropriate care and supervision to assist R1 with pressure injuries. Therefore, the allegation of "Staff neglect resulted in a resident sustaining multiple pressure injuries.” is deemed substantiated at this time. The following deficiencies were issued and recorded on LIC9099-D. Licensee was informed that an immediate Civil Penalty of $500.00 will be issued to the facility at the time of this visit. Additional civil penalty maybe be assessed at later time based on Health and Safety Code 1569.49. Exit interview was conducted. Appeal rights discussed and a copy of report was issued.the state’s words, verbatim · CDSS document, Dec 29, 2025 · control 31-AS-20241031153253

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a) · Plan of correction due date: Dec 30, 2025

Prohibited Health Conditions (a) Persons who require health services for or have health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by; The licensee admitted and retained R1 with Unstageable, Stage 3, 4 Pressure injuries. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 29, 2025

Plan of correction: Within 24h the administrator will provide written plan of actions, explaining the steps the Licensee will take to ensure not admit/retain persons with prohibited health condition.

Allegation investigated: Due to neglect, resident received skin tears and multiple pressure injuries. Staff are not following Hospice Care Plan.

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent visit to this facility to deliver the final report. LPA met with administrator Naira Paroyan and explained the reason for the visit. On 05.03.2024, the Woodland Hills South Adult and Senior Care Regional Office received a complaint alleging, “Due to neglect, resident received multiple pressure injuries.” The complainant was alleging that resident #1 (R1) arrived at the hospital with multiple pressure injuries, some Unstageable. R1 was in ICU as of 05/02/24. The complaint was referred to Community Care Licensing Division’s Investigations Branch (CCLD IB). The referral was accepted and assigned to Senior Investigator (SI) Christine Ferris. Continue to LIC 9099-C Substantiated On 05.06.2024 LPAs Ngo-Castaneda initiated the complaint. LPA conducted tour of the facility and obtained copies of pertinent information which include but are not limited to R1’s Physician’s Report, Admission Agreement, Resident Appraisal, Needs and Service Plan dated 10.28.2023 and other records related to the complaint allegation. LPA conducted interviews with the Administrator and three (3) out of six (6) residents, who were able to communicate. On 6.5.2024 SI Ferris conducted interview with, administrator; Staff #1 (S1) at 11:30AM, staff #3 (S3) at 12:00 PM, staff #2 (S2) at 1:30PM, resident #3 (R3) at 2:30PM, resident #6 (R6) at 2:45PM, resident #4 (R4) at 3:00PM, resident #1 (R1) at 3:30PM. Wound specialist was interviewed on 7.2.2024 at 8:30AM. Between 7.11.2024 and 07.23.24 hospice nurses, hospital social worker and nurses were interviewed. On 06/12/24 SI Ferris reviewed R1 medical records from hospice and hospital. (The records were subpoena on 05/16/24) Allegation#1: Due to neglect, resident received skin tears and multiple pressure injuries. The investigation revealed that R1 had been living at this facility since 10.28.2023. Upon R1’s admission to the facility, R1 was noted to have infection and inflammatory reaction and other complicated health conditions. Per assessment records from hospice, on 10/28/23 at the time of admission to the facility, R1 had stage 2/3 wounds. The Administrator and staff have knowledge of R1’s health conditions and complications. Staff revealed that they were not aware of R1 having skin tears. R1 was private person and was able to care for their ADL including bathing, and toileting. Although facility staff were advised by hospice nurses how to assist R1 when hospice was not present, staff relied on wound care specialists and hospice nurses assuming that they were providing care that R1 needed. A review of facility records revealed that R1 was receiving Hospice services which was initiated prior to R1’s admission to the facility. Between 08/21/23 and 05/01/24 R1 was receiving wound care services by wound care specialists, visiting R1 once a week. A review of the hospice visits and wound care notes, between 01/24/2024 through May 1, 2024, revealed that “R1 needed maximum assistance with all activities of daily living. (ADL) which included standing with maximum support. Required assistance communicated to the caregiver. The caregivers were also reminded “to reposition the resident every two hours to prevent pressure ulcers and to “promptly notify hospice of any concerning changes in the patient`s condition…” Continue to LIC 9099-C On 04/05/24 the wound care specialist identifies a second wound as a “new vascular stasis ulcer” which takes longer to heal. Between 04/05/24 and 04/30/24 wound care visit report identified that both wounds were not healing. On 05/01/24, R1 had nose bleeding for 3 days and leg bleeding. On 05.02.2024, R1 was admitted to the hospital with knee wound bleeding, unstageable pressure Injury and Stage 3 Pressure Injuries on right and left posterior thighs. Overall investigation revealed that R1 was admitted to the facility with complicated health conditions and stage 3 pressure injury with large amount of drainage. While R1 continued to remain in the facility, conditions(s) of the pressure injuries were worsening. Although hospice nurses and wound care specialists were responsible for providing wound care, staff failed to follow instructions received from the health care professionals to provide required assistance and reposition R1 every two (2) hours. Based on the interviews and record review, the facility admitted and retained R1 with prohibited health conditions and failed to assist R1 as per instructions received by medical professionals. Staff also failed to seek medical attention in a timely manner when R1’s condition was worsening. Therefore, the allegation is Substantiated at this time. Allegation #2: Staff are not following Hospice Care Plan It was alleged that facility staff are not following hospice care plan. Interview with staff revealed that they did not assist R1 with ADLs and did not touch or assist R1 with repositing since R1 did not want to be touched. Staff rely on medical personnel to provide required care for R1. A review of R1’s hospice records conducted by the LPA Ngo-Castaneda on 12/06/25 revealed that facility staff were instructed to rotate and reposition R1 every two (2) hours. Per hospice records “Patient (R1) needed maximum assistance with all activities of daily living (ADLs) which included standing with maximum support. Required assistance communicated to the caregiver. The caregivers were also reminded to reposition the resident every two hours to prevent pressure ulcers and to “promptly notify hospice of any concerning changes in the patient`s condition…” Continue to LIC 9099-C Based on the information obtained during the course of the investigation the allegation is deemed substantiated at this time. The following deficiencies were issued and recorded on LIC9099D. Licensee was informed that an immediate Civil Penalty of $500.00 will be issued to the facility at the time of this visit. Additional civil penalty maybe be assessed at later time based on Health and Safety Code 1569.49 Exit interview was conducted. Appeal rights discussed and a copy of report was issued.the state’s words, verbatim · CDSS document, Dec 15, 2025 · control 31-AS-20240503115353

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a) · Plan of correction due date: Dec 16, 2025

Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by; The licensee admitted and retimed R1 with Stage 3 Pressure injuries. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 15, 2025

Plan of correction: The administrator will ensure the facility shall not admit/retain persons a prohibited health condition which require health services including, but not limited to Stage 3 and 4 pressure injuries. Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Licensee to submit a faxed or mailed copy of POC by due date. An immediate penalty of $500 shall be assessed of R1.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(d) · Plan of correction due date: Dec 16, 2025

A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs… This requirement is not met as evidenced by. The licensee did not follow specific instructions to assist R1 as provided by the health care professionals. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 15, 2025

Plan of correction: The Administrator will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to 87464(d) All proof must be sent to the LPA by the POC due date.

Type of visit: Case Management - Deficiencies

LPA conducted an unannounced case management visit at this facility to issue citation for the deficiency discovered during the course of the investigation of complaint control number 31-AS-20241031153253. Facility does not have R1 re-appraisal for not documenting new physical condition. Licensing Program Analyst (LPA) Leslie Ngo-Castaneda delivered, in person, an amended LIC 9099 and LIC 9099-C complaint investigation report in association with complaint report# 31-AS-20241031153253, and the initial complaint investigation visit conducted on 2.5.2025 Citation issued. Appeal rights discussed and given. The Amended LIC 9099 and LIC 9099-C Complaint Investigation Report was hand delivered to administrator, PAROYAN, NAIRA.the state’s words, verbatim · CDSS document, Sep 3, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(b) · Plan of correction due date: Sep 17, 2025

The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. This requirement was not met as evidenced by: Based on LPA record reviews, facility administartor does not have re-appraisal for R1 brusing while in care which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 3, 2025

Plan of correction: Facility administrator agreed to write LPA a letter that moving forward, re-appairsal needs to be done for resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda delivered, in person, an amended LIC 9099 and LIC 9099-C complaint investigation report in association with complaint report# 31-AS-20241008114501, and the initial complaint investigation visit conducted on 2.5.2025 The Amended LIC 9099 and LIC 9099-C Complaint Investigation Report was hand delivered to administrator, PAROYAN, NAIRA.the state’s words, verbatim · CDSS document, Jul 23, 2025

Allegation investigated: Facility did not ensure resident is free from abuse. Staff do not ensure that resident's hygiene needs are met while in care.

This is an amendment to the original report issued on 2.05.2025. Additional information was added to clarify the investigation. Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted a subsequent complaint visit to the facility to investigate the above allegations. LPA met with the administrator, Naira Paroyan, and advised her about the visit. At 10:00 AM LPA conducted a physical plant tour to ensure the health and safety of the clients in care. An entrance interview was conducted. Allegation #1: Facility did not ensure resident is free from abuse. Continue to LIC 9099-C Substantiated Regarding the above allegation, it is alleged that the facility did not ensure the resident is free from bruising. On 10.9.2024 at 9:25 AM, LPA requested the resident and staff roster. At 9:45 AM, LPA requested copies of pertinent information which include, but are not limited to Physician’s report, Admission Agreement, Staff Training, LIC 500 (Personnel Report), LIC 9020 (Resident Roster), hospice records, needs and service plan, and relevant documents to the investigation. Between 10 AM-10:30 AM, LPA interviewed the Administrator and two (2) out of two (2) staff and four (4) out of six (6) residents, who are in the facility. LPA visited Resident #1 (R1) at US Renal Care in Van Nuys on 10.9.2024 at 12:25 PM. LPA observed that R1 had multiple bruising on bilateral forearms, bruising on right-hand phalanges, and skin tears on the right (R) bicep measure 0.5 x 1 inch. R1 right eye tear duct was also full of morning glories. Interviews with the residents revealed that the facility staff does not reposition appropriately. When assisting and/ or repositioning staff would either push the resident against the wall while in bed and or against the bed-rail which causes R1 bruising. LPA interviewed R1 and reviewed the Centrally Stored Medication Destruction Record (CSMDR) to determine whether medications could have caused the bruising. Upon review R1 is not taking any blood thinners or other medications that would cause the bruising. This was also confirmed by the resident. LPA reviewed staff records for training regarding care. The staff has undergone forty (40) hours of training upon on-boarding to the facility before caring for residents. While staff had documented training it appears that staff lacked knowledge in appropriately repositioning a resident to prevent bruising. Staff could have used a bed sheet to shift the resident or other approach to avoid harming and bruising the resident. The facility failed to take alternate appropriate measures to ensure that there was no immediate threat to the health and safety of the residents. Overall, the investigation revealed that the facility Administrator was aware of R1's care. Based on the information revealed from interviews and records review, there is sufficient information to support the above stated allegation. Therefore, the allegation is determined to be substantiated at this time. Allegation #2: Staff do not ensure that resident's hygiene needs are met while in care. The complaints’ concern more specifically is that the Administrator/Staff did not assist R1 in obtaining appropriate dental care. On 10.9.2024 at 12:25 PM LPA conducted a collateral visit at US Renal Care in Van Nuys CA. LPA met with R1 for an interview. Aside from the bruising seen on R1, LPA observed R1 teeth to be very grayish close to black. Prior to the collateral visit LPA reviewed R1’s preplacement appraisal dated 11-02-2023, Appraisal Needs and Service plan dated 11-02-2023, Admissions agreement dated 11-02-2023, and Physicians Report dated 11-01-2023. Per the resident admissions agreement the resident is paying for assistance with meeting necessary medical and dental needs, including arranging for transportation. The pre-placement appraisal indicated R1 needs assistance with personal hygiene however it is not explained. The Appraisal Needs and Service plan does not indicate what the resident #1 (R1) dental needs were, nor was there a plan to address it. The physician’s report indicates that R1 does not wear any dentures but does need assistance with grooming. LPA did not observe any records of R1 visiting a dental professional or other appropriate skilled professional. According to R1 and dialysis staff, facility staff do not assist with oral hygiene teeth cleaning. The Administrator or Staff did not assist with contacting an appropriate skilled professional (Dentist) to address R1’s dental needs. LPA interviewed the administrator and staff, interviews unanimously revealed they are aware of R1's tooth decay. There was no plan in place to address the issue. Based on the observation, interviews, and records review, there is sufficient information to support the above stated allegation. Therefore, the allegation is determined to be substantiated at this time. Exit interview conducted. Appeal rights are given.the state’s words, verbatim · CDSS document, Feb 5, 2025 · control 31-AS-20241008114501

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Feb 6, 2025

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Based on LPA observation facility failed to schedule a dentist appointment for R1 where their teeth was graying close to black due to gingivitis.the state’s words, verbatim · CDSS document, Feb 5, 2025

Plan of correction: Licensee shall submit a vendor training on staff to prevent injuries and give the proper care to residents in care as a result of this deficiencies. Licensee shall submit to CCL no later than 2.6.2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465.1(a)(3) · Plan of correction due date: Feb 6, 2025

(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 evidenced by: Based on LPA record reviews, observation, & interviews, R1 bruses was developed at the facility while in care which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 5, 2025

Plan of correction: Licensee shall submit a vendor training on staff to prevent injuries and give the proper care to residents in care as a result of this deficiencies. Licensee shall submit to CCL no later than 2.6.2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. At 9:30 am Naira Paroyan who is the administrator met with LPA, explained the reason for the visit. At 10:00 am, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen, hallway and living room. The charge date is 12/`0/2024. During the visit the facility is at 76 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents, one of which may be bedridden in room #2 and room #4 only, hospice waiver is approved for 6. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the garage. Bedrooms: There were five (5) bedrooms in the facility, four (4) bedrooms are designated for residents' use and one (1) bedroom is designated for staff. Bedroom #1 and bedroom #2 are used for private, bedroom #3, bedroom #4 is shared. The bedrooms are used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Bedroom #5 that is located at the hallway for staff and is kept locked from resident access. Continue to LIC 809-C Bathrooms: There are two and a half (2.5) bathroom designated for residents' use. The bathrooms were properly supplied and has functional fixtures. Hot water temperature was measured at 111.1 degrees Fahrenheit for bathroom #1 located inside beside room #1, which is a half-bath. Bathroom #2 is beside bedroom #0.5 and is for staff use only. Bathroom #2 is across bedroom #3. Hot water temperature was measured at 111.1 degrees Fahrenheit. There was enough clean linen available in the cabinets in the hallway. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Office is located beside the dining area. Fireplace is close and non-operational. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Infection control: Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have a swimming pool or body of water. The garage attached and is used for storage and staff refrigerator. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the laundry area and is located in the garage. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. Continue to LIC 809-C Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. Resident records were reviewed for requirements and legibility: LPA reviewed all of the client’s files for current appraisal for the residents. Liability insurance a copy was handed to LPA. Planned activities are offered. Facility is within CA code of Regulations Title 22 or Health and Safety Code. No deficiencies were found, exit interview conducted, copy of report has been issued and discussed.the state’s words, verbatim · CDSS document, Feb 5, 2025

Type of visit: Case Management - Deficiencies

On 11.01.2024 in conjunction with an initial complaint visit control number 31-AS-20241031153253. Licensing Program Analyst (LPA) Leslie Ngo-Castaneda and Licensing Program Manager (LPM) Nichelle Gillyard completed an unannounced CASE MANAGEMENT- Deficiencies visit. LPA met with Licensee Naira Paroyan, explained the purpose of the visit. During the facility tour at 10:01AM . LPA observe the following: Storage of oxygen in the room was seen in bedroom #1 and bedroom #4 at 10:02 AM, but no oxygen sign was present in the bedrooms doors. Window screens were broken in bedroom #1 located beside the television was observed at 10:02AM. Medication for R4 was left on the kitchen counter in a plastic container at 10:13AM. S3 is a new staff needs proper training before starting working at the facility. LPM and LPA observed video footage has audio and showed bedroom #1 and 3, residents rights were violated. Per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiency was observed and cited (Refer to LIC 809-D). Copy of this report provided, appeal rights given. Exit interview conducted.the state’s words, verbatim · CDSS document, Nov 1, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87618(b)(3)(b) · Plan of correction due date: Nov 15, 2024

Ensuring that the use of oxygen equipment meets the following requirements: "No Smoking-Oxygen in Use" signs shall be posted in the appropriate areas.This requirement is not met as evidenced by: LPA and LPM did not observe 'oxygen in use' sign. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Administrator needs to post a 'No Smoking-Oxygen in Use" sign on the bedroom door.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Nov 15, 2024

Maintenance and operation: The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met. as evidenced by: LPA and LPM observed the facility screen was in disrepair. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Administartor needs to ensure that screens located within the facility are clean and in good repair.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Nov 2, 2024

Incidental medical and dental Care: The following requirements shall apply to medications which are centrally stored:Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the medication. supervision of the centrally stored. This requirement is not met by staff leaving a pill in a covered cup for R4 in the kitchen counter that is accessible to the residents in the facility. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Staff needs to lock and store medication of residents. POC was done during today with administrator. Medication was stored and lock away in the locked medicine cabinet.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.925(b)(1) · Plan of correction due date: Nov 3, 2024

(b) (1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours... restricted health conditions, and hospice care... before working independently with residents. This was evident by LPM and LPA review of records for S3. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Administrator needs to ensure S3 has the proper vendor training before working at the facility. Administrator will email schedule of the training and upon completion or staff sign-in sheet with training material for all staff that assist with medication.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Nov 8, 2024

Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) to have a reasonable level of personal privacy in accommodations, medical treatment, personal care and ... of resident and family groups. This requirement is not met as evidenced by: LPA and LPM did not observe camera surveillance to having audio and looking into S1 bedroom. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Administrator will ensure that the camera surveillance does not have any audio and be reposition so that it would not look into bedroom #1 and bedroom #3. Administrator will be sending a certifcation that audio is off.

Type of visit: Collateral

At 12:25 PM, Licensing Program Analysts (LPA) Leslie Ngo-Castaneda conducted unannounced collateral visit to the facility in conjunction with a complaint control #31-AS-20241008114501. LPA met with the staff and disclosed the reason for the visit. The purpose of this collateral visit is to conduct an interview with one (1) resident and staffs for a complaint visit (#31-AS-20241008114501). LPA also obtained copies of pertinent documents relevant to the complaint investigation. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Oct 9, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. At 10:10 am Naira Paroyan who is the administrator met with LPA, explained the reason for the visit. At 10:00 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen, hallway and living room. The charge date is 1/30/2024. During the visit the facility is at 75 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents, one of which may be bedridden in room #2 and room #4 only, hospice waiver is approved for 6. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the garage. Bedrooms: There were five (5) bedrooms in the facility, four (4) bedrooms are designated for residents' use and one (1) bedroom is designated for staff. Bedroom #1 is used for private, bedroom #2, bedroom #3, bedroom #4 is shared, but bedroom #2 and bedroom #3 has only one resident for now. The bedrooms are used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Bedroom #5 that is located at the hallway for staff and is kept locked from resident access. Continue to LIC 809-C Bathrooms: There are two and a half (2.5) bathroom designated for residents' use. The bathrooms were properly supplied and has functional fixtures. Hot water temperature was measured at 107.8 degrees Fahrenheit for bathroom #1 located inside beside room #1, which is a half-bath. Bathroom #2 is beside bedroom #2. Hot water temperature was measured at 111.6 degrees Fahrenheit. Bathroom #3 is across bedroom #3. Hot water temperature was measured at 111.1 degrees Fahrenheit. There was enough clean linen available in the cabinets in the hallway. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Office is located beside the dining area. Fireplace is close and non-operational. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Infection control: Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have a swimming pool or body of water. The garage attached and is used for storage and staff refrigerator. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the laundry area and is located in the garage. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. Continue to LIC 809-C Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. Resident records were reviewed for requirements and legibility: LPA reviewed all of the client’s files for current appraisal for the residents. Liability insurance a copy was handed to LPA. Planned activities are offered. Facility is within CA code of Regulations Title 22 or Health and Safety Code. No deficiencies were found, exit interview conducted, copy of report has been issued and discussed.the state’s words, verbatim · CDSS document, Jan 30, 2024

Allegation investigated: Staff speaks inappropriately to resident in care Staff do not provide adequate food service to resident in care Staff refuse to provide hygiene supplies to resident in care Resident in care is not provided privacy by facility staff

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility to investigate the above allegation. LPA met with Cynthia Cherriel and explained the reason for the visit. Administrator Naira Paroyan designated Cynthia Cherriel as the responsible person to sign and accept the report. --- Staff speaks inappropriately to resident in care. It was alleged that staff verbally abuse residents. To investigate the allegation on 06/26/2023 LPA interviewed one (01) staff and one (01) resident from 9:10 AM to 09:40 AM. On 10/16/2023, LPA interviewed one (01) additional staff and five (05) out of six (06) residents from 12:15 PM – 1:30 PM. During interviews with staff, all staff stated that they do not speak to residents inappropriately and are kind to all residents. (CONT. LIC812-C) Unsubstantiated Staff added that Resident #1 (R1) would use foul language towards staff and residents. During interviews with residents, R1 stated that staff are verbally abusive, however, all other residents stated that staff do not speak to them inappropriately. Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. --- Staff do not provide adequate food service to resident in care. It was alleged that facility is not providing meals according to dietary needs. To investigate the allegation on 06/26/2023 LPA interviewed one (01) staff and one (01) resident from 9:10 AM to 09:40 AM. On 10/16/2023, LPA interviewed one (01) additional staff and five (05) out of six (06) residents from 12:15 PM – 1:30 PM. During interviews with staff, all staff stated that they are aware of the residents’ dietary needs, such as no sodium and low sugar diets, and provide meals accordingly. Staff added that resident would grab the saltshaker, add salt and use other ingredients against their advice. During interviews with residents, Resident #1 (R1) stated that staff are not providing no sodium diet meals, however, all other residents stated that staff provide adequate food services according to their diet. Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. ---Staff refuse to provide hygiene supplies to resident in care It was alleged that facility does not provide residents with toilet paper. To investigate the allegation on 06/26/2023 LPA conducted physical plant tour at around 08:15 AM and interviewed one (01) staff and one (01) resident from 9:10 AM to 09:40 AM. On 10/16/2023, LPA interviewed one (01) additional staff and five (05) out of six (06) residents from 12:15 PM – 1:30 PM. During the physical plant tour, LPA observed toilet paper in each bathroom and that the facility had approximately 30 rolls of toilet paper and 10 rolls of paper towels in storage cabinets. During interviews with staff, all staff stated that toilet paper is always made available to residents. During interviews with residents, Resident #1 (R1) stated that staff are not providing toilet paper, however, all other residents stated that they always have toilet paper available to them. (CONT. on LIC812-C) Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. --- Resident in care is not provided privacy by facility staff It was alleged that staff listen to resident’s telephone conversations. To investigate the allegation on 06/26/2023 LPA interviewed one (01) staff and one (01) resident from 9:10 AM to 09:40 AM. On 10/16/2023, LPA interviewed one (01) additional staff and five (05) out of six (06) residents from 12:15 PM – 1:30 PM. During interviews with staff, all staff stated that they do not listen to resident’s conversations and give residents plenty of privacy. During interviews with residents, Resident #1 (R1) stated that staff listen in on their conversation and are always being nosey, however, all other residents stated that they have enough privacy during telephone conversations. Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No health and safety hazards noted during the visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 16, 2023 · control 31-AS-20230623152503