Velvet Care 2

Allegation investigated: Staff did not meet resident's incontinence care needs. Staff spoke inappropriately to residents Staff did not allow residents to leave their beds

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced initial visit for the above allegation. LPA met with staff designee (S1), Cynthia Sherriel, and explained the reason for the visit. At 10:17 AM administrator, Naira Paroyan, arrived and was informed of the reason of the visit. LPA took a tour of the physical plant at 9:05AM. At 9:21 AM, LPA interviewed the administrator (S3) and two (2) staff. At 10:20 AM, LPA interviewed a total of four (4) residents. At 11:00 AM LPA conducted a records review of R1's file, as well as other relevant documents, including the physician's report, admission agreement, LIC 500 (staff roster), resident roster (LIC 9020), preplacement appraisal, and other pertinent documents. Allegation: Staff did not meet the resident's incontinent care needs. Continue to LIC 9099-C Unsubstantiated It is alleged that resident #1 (R1) would wait up to three (3) to four (4) hours to be assisted with incontinence care. Interviews with four (04) out of four (04) residents revealed they have their incontinence needs met in a timely manner. Residents' interviews revealed that they are being changed, cleaned, checked, and repositioned every two (2) hours and do not leave residents soiled for an extended time. Residents' interview revealed that R1 is very demanding and would yell at the staff to be assisted immediately. Interviews with the administrator and staff revealed that residents are being checked every two (2) hours. S1 stated that residents would wait at most ten (10) minutes, not hours, when staff are preoccupied. During the physical plant tour, LPA did not experience any malodor. A review of R1’s Home Health documents indicate Home Health nurse, PT and OT visited the facility for assistance with physical therapy, occupational therapy, and checking vitals. Based on interviews and observations, staff assist residents in a timely manner. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Allegation: Staff spoke inappropriately to residents It is alleged that staff would say to R1 to “go to sleep” when requested to be changed. During interviews with residents, all residents stated that staff do not say things to them like “go to sleep” and staff treat them with respect and dignity. During interviews with staff, all staff stated they treat residents with respect and dignity. Staff added that they do not tell residents “go to sleep”; they can sleep whenever they want. Whenever assistance is requested by residents, it is provided, and staff would never speak inappropriately. Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Allegation: Staff restricted residents from leaving their beds It is alleged that facility staff restricted R1 from leaving their beds. Interview with the Administrator and staff stated that residents are not restricted from leaving their beds. Additionally, staff reported accompanying residents when necessary for safety reasons. Continue to LIC 9099-C R1’s physician report notes their bed-bound. Interviews with four (4) out of four (4) residents stated they are not restricted from their beds and may walk around or leave the facility unattended if independent. unattended if independent. LPA observed half bed rails in R1’s bed and a bed rail physician’s order was observed on file. Based on observation and interviews, this allegation is deemed Unsubstantiated at this time. Exit interview conducted, and a copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Mar 30, 2026 · control 31-AS-20260326155424

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. At 9:26 AM staff designee, Cynthia Sherriel, was greeted by LPA and advised the reason of the visit. At 10:00 AM administrator arrive and was advise the reason of the visit. At 9:46 AM, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 11:04 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 12/04/2025. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents, one of which may be bedridden in room #3; 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 laundry area. Bedrooms: There were four (4) bedrooms in the facility, four (4) bedrooms are designated for residents' use. Bedroom #1 and bedroom #3 are used for private, bedroom #2 and bedroom #4 are shared. The bedrooms are used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Continue to LIC 809-C Bathrooms: There are two (2) bathrooms in the facility designated for residents' and staff use. The bathrooms were properly supplied and has functional fixtures. Hot water temperature was measured at 106.5 degrees Fahrenheit for bathroom #1 located inside in between room #2 and bedroom #4. Bathroom #2 is located in the hallway that is for staff use only. 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 living room area. Fireplace is close and non-operational. Fire place is located in the living room that is closed, non-operational and block off. 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 detached 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. 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, Dec 15, 2025

Allegation investigated: Staff chemically restrained resident in care. Resident was admitted to the facility without consent. Resident was prevented from moving out of the facility.

On 9.15.2025 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at the facility to conduct an unannounced subsequent complaint visit regarding the above allegation. LPA was greeted by Cynthia Sherriel (S2), who is the designated staff member of the facility. Entrance Interview conducted. At 10:00 AM with the assistance of S2, LPA conducted a physical plant tour to ensure the health and safety of the residents in care. Allegation #1: Staff chemically restrained resident in care. Continue to LIC 9099-C Unsubstantiated The complainant alleged that staff was using medication to sedate resident #1 (R1) as a form of restraint. On 7.9.2025, between 8:40 AM and 9:10 AM, LPA requested and obtained copies of facility documents, including but not limited to the Staff Roster (LIC 500) and the Resident Roster (LIC 9020). In addition, documents from the file of R1 include the Physician’s Report (LIC 602A), Admission Agreement, appraisals, and the Centrally Stored Medication and Destruction Record (LIC 622). Between 9:39 and 10:30am, interviews were conducted with the Administrator and the Responsible Person (W1) for R1 via telephone, and two staff members who assist residents with self-administration of medications. Information obtained did not corroborate the allegation of chemical restraints and indicated medication assistance was conducted based on the doctor’s orders. At 10:30am, LPA conducted interviews with five (5) out of five (5) residents. All residents denied having been chemically restrained or having any knowledge of such a practice occurring at the facility. During the visit, LPA observed the activities of the five residents, which included watching television, taking a walk, and having breakfast. All residents appeared alert and active. The information obtained and the observations of the LPA did not support the allegation, which has been deemed Unsubstantiated at this time. Allegation #2: Resident was admitted to the facility without consent. Regarding the allegation, it was reported that R1 was admitted to the facility without family consent. To investigate the allegation, LPA Ngo-Castaneda conducted interviews with the facility administrator and staff #2 (S2), reviewed R1 records, and interviewed residents. The administrator and S1 confirmed that prior to admission, R1 had no family and had been appointed a public guardian. Between 10:30 and 11:30 LPA interviewed five (5) out of five (5) residents. The information obtained indicated the residents consented to their admission and are happy living at the facility. At 1:30pm LPA conducted a telephonic interview with the public guardian assigned to R1. The information obtained confirmed the public guardian had chosen the facility for R1 and authorized R1’s admission. The information obtained, observations, and record review of the LPA did not support the allegation which has been deemed Unsubstantiated at this time. Continue to LIC 9099-C Allegation #3: Resident was prevented from moving out of the facility. Regarding the allegation, it was reported that R1 was prevented from transferring out of the facility. To investigate the allegation, LPA Ngo-Castaneda conducted interviews with the facility administrator and staff #2 (S2), reviewed R1’s records, and interviewed residents. The administrator and S1 advised that at the time of the admission, R1 had no known family and had been appointed a public guardian. Between 10:30 and 11:30, LPA interviewed five (5) out of five (5) residents. The information obtained indicated that they were happy living at the facility. At 1:30pm LPA conducted a telephonic interview with the public guardian assigned to R1. The public guardian advised that there were currently no plans for R1 to move out or transfer. Based on the information obtained, observations, and record review of the LPA, the allegation which has been deemed Unsubstantiated at this time. No immediate health and safety hazards were observed during this visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Sep 15, 2025 · control 31-AS-20250702114521

Allegation investigated: Staff handled resident in a rough manner. Staff are not safeguarding resident's personal possessions.

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 them 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: Staff handled resident in a rough manner. Complainant alleged that a resident in care, Resident #1 (R1) was handled roughly by staff and that the housekeeper was ‘trying to molest’ R1. To investigate the allegation, on 3.26.2025, LPA interviewed three (03) staff and interviewed six (6) of six residents from 1:24-3:15 PM. Continue to LIC 9099-C Unsubstantiated Interviews with staff included statements that they are always handling residents gently and are never rough with residents nor would they touch them inappropriately. Interviews with residents revealed, five (5) out of six (6) residents stated that staff are never rough handling them nor have they experienced being touched inappropriately. The information obtained during interviews does not corroborate the allegation. Based on the information obtained and observed, there is insufficient evidence to prove that the staff handled R1 roughly or inappropriately. Therefore, the allegation is deemed Unsubstantiated at this time. Allegation #2: Staff are not safeguarding residents' personal possessions. Complainant alleged that R1's belongings, including but not limited to a wallet containing money & credit card, and cell phone charger, were stolen. To investigate the allegation, at 10:00 AM, LPA conducted a physical plant tour. On 3.26.2025, LPA requested copies of facility documents including but not limited to R1’s physician report and the needs and service plan. Facility did not provide Resident Personal Property and Valuables inventory (LIC 621). LPA interviewed residents and staff between 1:24-3:15 PM. Record review revealed that R1 has a public guardian. LPA contacted the public guardian at 3:00 PM and was advised that the public guardian instructed the facility administrator to store R1's belongings. LPA observed the belongings stored in a cabinet in the Office area. Upon arrival, LPA observed that Los Angeles Police Department (LAPD) officers were at the facility in response to an earlier 911 call. Per the Administrator R1 would call 911 and LAPD to the facility. Upon LPA arrival at the facility, LPA Ngo-Castaneda met with LAPD, and it was advised that the facility is at no fault and that R1 has called LAPD twice for false accusation. To protect R1, the facility was instructed by R1 public guardian to store R1's belongings (money/ credit card and cell charger). Interviews with the six (6) residents at the facility, resulted in five (5) out of six (6) residents stating that they have not had personal belongings lost or stolen and indicated that they are happy and safe living at the facility. Based on inspection, observation, interviews, and record reviews, it was concluded that there is insufficient information to corroborate the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No immediate health and safety hazards were observed during this visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Sep 15, 2025 · control 31-AS-20250326085659

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 designee Cynthia Sherriel was greeted by LPA and advised the reason of the visit. At 9:45 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 12/05/2023. During the visit the facility is at 74 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents, one of which may be bedridden in room #3; 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 laundry area. Bedrooms: There were four (4) bedrooms in the facility, four (4) bedrooms are designated for residents' use. Bedroom #1 and bedroom #3 are used for private, bedroom #2 and bedroom #4 are shared. The bedrooms are used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Continue to LIC 809-C Bathrooms: There are two (2) bathrooms in the facility designated for residents' and staff use. The bathrooms were properly supplied and has functional fixtures. Hot water temperature was measured at 105.4 degrees Fahrenheit for bathroom #1 located inside in between room #2 and bedroom #4. Bathroom #2 is located in the hallway that is for staff use only. 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. Fire place is located in the living room that is closed, non-operational and block off. 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 detached 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. 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, Nov 26, 2024

Allegation investigated: Facility staff abusing residents.

On 5.29.2024 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at the facility to conduct an unannounced complaint visit regarding the above allegation. LPA was greeted by Cynthia Sherriel (S2) who is the designated staff of the facility. Entrance Interview conducted. At 10:03 AM with the assistance of the staff, LPA conducted a physical plant tour to ensure the health and safety of the residents in care. A case management deficiency will be cited for the unauthorized alteration having a passageway from the garage to the facility. Record review, LPA received: admission agreement, ID and emergency information, appraisal, physicians report, CSMDR, and all other necessary documents. Allegation: Facility staff abusing residents. Continue to LIC 9099-C Unsubstantiated Regarding the allegation of “Facility staff abusing residents.” it was alleged staff #1 (S1) member abused Resident #1 (R1). At 10:30 AM LPA interviewed R1 it was alleged that S1 would handle changing them roughly, and profanity and abusive words would be yelled by S1. LPA did not observe any bruising and R1 stated that no bruising has ever happened that would be caused by staff. At 10:45 AM-11:15 AM, LPA interviewed four (4) out of five (5) residents and stated that no abuse was seen or experienced at the facility. Residences are happy and content with the facility and were very appreciative of the facility staff. At 11:15 AM interview with S2 stated that R1 can be very difficult and verbally abusive towards all the staff and staff would just continue with the care needed to be given. At 11:25AM an interview with S1 revealed that R1 can be difficult but care is still given to all the residents. Staff would constantly do rounds to ensure all the residents health and safety. At 11:30 AM- 12NN LPA contacted two (2) family members of R1 and stated that R1 would always complain about a facility and is never content and would make up such allegation. A family member also visited R1 last week and no complaint was stated observed R1 to have no bruising or discomfort. Interviews with other residents and staff revealed no information about staff verbally abusing residents. Based on interviews, facility staff did not verbally abuse R1. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. No immediate health and safety hazards were observed during this visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, May 29, 2024 · control 31-AS-20240521091912

Type of visit: Case Management - Deficiencies

On 05.29.2024 in conjunction with an initial complaint visit control number 31-AS-20240521091912. Licensing Program Analyst (LPA) Leslie Ngo-Castaneda completed an unannounced CASE MANAGEMENT- Deficiencies visit. LPA met with designated licensee Cynthia Sherriel, explained the purpose of the visit. From 10:15AM to 11:30AM, interviewed (4) out of four (4) staff and four (4) out of five (5) residents. During the interview and observation it was revealed the facility made a passageway from the garage to the facility hallway without any prior approval from fire department any advice to the regional office. Facility sketch did not include the new construction to the garage to the hallway. The new construction does not have a permit to use this area as a passageway. Therefore, the allegation is deemed substantiated. According to the California Code of Regulations, Title 22, Division 6, the following deficiency is cited: See LIC 9099-D for citation. Appeal Rights Discussed/An Exit Interview was conducted. A copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 29, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87305(a) · Plan of correction due date: May 29, 2024

Section 87305(a) Alterations to Existing Building or New Facilities. Prior to construction or alterations, all facilities shall obtain a building permit. LPA observed that a portion of the garage has a new passageway from the garage to the hallway of the facility.the state’s words, verbatim · CDSS document, May 29, 2024

Plan of correction: Liciensee shall remove, close and lock the passageway from the garage and the hallway and agrees to comply with Title 22 regulations regarding accommodations. Plan of correction is due by 6.12.2024

Allegation investigated: Residents bedroom is being used as a passageway to another room. The garage is used as a living space for staff.

On 4.10.2024 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at the facility to conduct an unannounced complaint visit regarding the above allegations. LPA was greeted by Cynthia Sherriel (S1) who is the staff of the facility. At 10:30 AM Hayk Kirokosyan who is the licensee arrived at the facility and explained the reason for the visit. An entrance interview was conducted. At 10:05 AM LPA conducted a physical plant tour with the assistance of the staff to ensure the health and safety of the residents in care. Allegation: Residents bedroom is being used as a passageway to another room. Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an initial complaint visit. Regarding the allegation above it is alleged that residents bedroom is being used as a passageway to another room (garage). Continue to LIC 9099-C Substantiated It was alleged that residents bedroom #3 and bedroom #4 was used as a passageway for staff to enter the garage (staff bedroom) or exit the facility. To investigate the complaint, LPA interviewed staff and residents from 10:30-11:30 AM. LPA interviewed four (4) out of four (4) staff and four (4) out of five (5) residents. During the interview for the residents, R2 who resides in bedroom #4 stated that their bedroom is used as a passageway that leads to the garage, which is the staff bedroom. R2 spends most of their time in their bedroom and stated that staff would enter bedroom #3 and bedroom #4 without knocking, look at R2, and just walk by to use the exit door that leads to the garage (staff bedroom) or exiting the facility. R5 is bedridden and advised LPA that their bedroom #3 is used as a passageway to exit the facility. Therefore, this allegation is SUBSTANTIATED. Allegation: The garage is used as a living space for staff. It was alleged that the facility used the garage as a staff living space. According to the facility sketch and observation on 12.5.2023, the facility is approve for four (4) bedroom, garage as a storage, kitchen, living room and two (2) bathrooms. To investigate this complaint, during LPA facility tour at 10:05 AM. LPA observed that the garage has an air-conditioning unit, queen mattress with full bed frame, sofa, incontinent supplies, staff belongings, PPE storage and staff refrigerator. Four (4) out of four (4) staff confirmed that the garage is where staff sleeps. Three (3) out of five (5) residents confirmed that the staff lives in the garage. Licensee and staff confirmed that the garage is not permitted for living/sleeping area, it is only for storage. The garage has a male and female staying in the garage room and was later identified as administrator's parents that are hired to be the staff in the facility. Licensee acknowledged that staff do sleep in the garage area. Licensee reported that they will not allow any person(s) to reside in the garage any longer and staff schedule for LIC 500 will be updated. Based upon the findings of the investigation, the above allegation is deemed SUBSTANTIATED at this time. Following citation is issued for the identified deficiency pursuant to Title 22 regulations. Exit interview conducted, appeal rights discussed, copy of this report is provided.the state’s words, verbatim · CDSS document, Apr 10, 2024 · control 31-AS-20240409084443

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(d)(6) · Plan of correction due date: Apr 24, 2024

Personal Accommodations and Services: The following space and safety provisions shall apply to all facilities: All outdoor and indoor passageways and stairways shall be kept free of obstruction. All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: The staff uses bedroom #4 as a walkway as a pass through that leads to the garage.the state’s words, verbatim · CDSS document, Apr 10, 2024

Plan of correction: Licensee/administrator will submit a written statement notifying the department what steps will be taken to clear this deficiency and to ensure such deficiency will not reoccur.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a) · Plan of correction due date: Apr 24, 2024

Personal Accommodations and Services: Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. This requirement is not met as evidenced by: Facility used the garage as a staff living space.the state’s words, verbatim · CDSS document, Apr 10, 2024

Plan of correction: Personal belongings needs to be removed and an updated LIC 500 since staff would not be living in facility anymore.

Type of visit: Case Management - Deficiencies

On 04.10.2024 in conjunction with an initial complaint visit control number 31-AS-20240409084443. Licensing Program Analyst (LPA) Leslie Ngo-Castaneda completed an unannounced CASE MANAGEMENT- Deficiencies visit. LPA met with Licensee Hayk Kirokosyan, explained the purpose of the visit. From 10:30AM to 11:30AM, LPA interviewed four (4) out of four (4) staff and four (4) out of five (5) residents. During the interview R2 advised LPA that their bedroom #4 is used as a passageway for staff to use the exit door to gain entrance to the garage. R2 stated that staff would just barged into their bedroom without knocking. Because of such action staff is violating the residents personal rights for privacy. 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, Apr 10, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(A)(1) · Plan of correction due date: Apr 24, 2024

To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement is not met as evidenced by: Staff would just barged into bedroom #4 without knocking in order to gain access for the exit doors that leads to the garage.the state’s words, verbatim · CDSS document, Apr 10, 2024

Plan of correction: Licensee/administrator will submit a written statement notifying the department what steps will be taken to clear this deficiency and

Type of visit: Prelicensing

At 10:00am Licensing Program Analyst (LPA), Angela Panushkina conducted an announced Pre-Licensing visit to the above facility and met with Applicant/Licensee, Hayk Kirakosyan and Administrator, Naira Paroyan. Fire Clearance was approved on 10/26/2023 for a maximum capacity of six (6) residents, of which five (5) Non-Ambulatory and one (1) bedridden residents in room #3. Hospice waiver for six (6) residents was approved on 12/05/23. 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 that is equipped with a refrigerator, microwave oven and sink. At 10:10am, LPAs 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. Fire Extinguisher was last purchased on 12/05/23. BEDROOMS: There are four (4) bedrooms designated for client use. 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. BATHROOMS: At 10:25am LPA observed two (2) bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 112.5°F. LPA observed appropriate grab bar and had non-skid mat. Continue on LIC809-C COMMON AREAS: The facility maintains a comfortable temperature at 75°F. The living room and dining appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. LAUNDRY ROOM: The laundry room is located by the kitchen area. The washer/dryer appear to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. MEDICATION: The medication will be kept in a locked cabinet also located in the laundry room. The facility staff/resident files will be kept in a file cabinet in the living room area. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 10:50am they were tested and observed to be operational. SURROUNDING GROUNDS: In the back of the facility has sufficient yard space. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. The backyard is fenced. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. There are no bodies of water GARAGE: The garage is detached and currently being used for storage. LPA observe the garage locked and inaccessible to residents in care. Component III was conducted with the 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, Dec 5, 2023

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Hayk Kirakosyan, Naira Paroyan Interview Method: Telephone interview On November 02, 2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Nov 2, 2023