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Type of visit: Case Management - Deficiencies

Licensing Program Manager (LPM) Mary Flores and Licensing Program Analyst(LPA) Nadia Shahbazian conducted a case management visit to note deficiencies noted during pre-licensing visit. LPA met with staff and explained the reason for the visit. On 7/16/26 a pre-licensing visit was being conducted due to change of ownership and the following deficiencies were observed: Patio porch was observed with two boards with holes of about 1 foot each, one side was lifted, and side board was off the fence. Medication sheets were observed with errors for Resident #4(R4) dosage per day was incorrect instead of twice a day it was noted as once a day for Metoprolol 25mg and Resident #2(R2)'s Telmisarartan 40mg was noted as Telmisaratan 50mg. Deficiencies noted under Title 22 Regulations. Exit interview was conducted with caregiver and a copy of this report, LIC 809D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 16, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jul 23, 2026

87303 Maintenance and Operation: (a) 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 evidence by: Based on observation licensee did not ensure the back porch was in good repair as observed to have 2 holes in the boards and not level which poses a potential risk to the health, safety, personal rights of the residents in care.the state’s words, verbatim · CDSS document, Jul 16, 2026

Plan of correction: Licensee will repair the porch and submit pictures to the department by POC due date 7/23/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(a) · Plan of correction due date: Jul 23, 2026

87411 Personnel Requirements - General: (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requrement is not met as evidence by: Based on document review licensee that R2 and R4's medication list was correctly enter with dosage and medication description which poses a potential risk to the persons health, safety, personal rights of the persons in care.the state’s words, verbatim · CDSS document, Jul 16, 2026

Plan of correction: Licensee will provide training to staff on medication records and will provide a copy to the department by POC due date 7/23/26.

Type of visit: Office

Licensing Program Manager (LPM) Mary Flores and Licensing Program Analyst(s) (LPA)s Nadia Shahbazian and Leslie Ngo-Castaneda conducted an Informal Office Meeting at the Woodland Hills South Regional Office with Administrator-Moe Saki and new applicant, Tigran Gevorgyan. During the meeting the following was discussed: The purpose of the meeting was explained to the administrator and the new applicant. LPM mentioned that the Corporation was dissolved without notifying the California Department of Social Services (CDSS) During the annual visit on 03/25/2026 it was discovered that Administrator-Arusyak Ohanyan is no longer employed at the facility and the licensee was over seeing the facility. The Licensee failed to notify CDSS of change of ownership. Multiple deficiencies were identified during the annual visit on 03/25/2026 and plan of correction and appeal rights were provided. Administrator requested to update facility email address and telephone number. Facility's licensing corporation was dissolved on 5/18/25. Per licensee they did were not aware that the corporation needed to remain active during the change of ownership. Deficiency was noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Moe Saki Administrator and a copy of thus report was provided.the state’s words, verbatim · CDSS document, May 27, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87205(b) · Plan of correction due date: May 28, 2026

87205: Accountability of Licensee Governing Body (b) If the licensee is a corporation or an association, the governing body shall be active, and functioning in order to assure accountability. Based on document review, the corporation was dissolved on 05/18/2025 which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 27, 2026

Plan of correction: Administrator will email LPA a copy of the documents submitted to Central Application Bureau to verify submission of documents for pending application or will ensure that corporation is reenstated by POC due date

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with staff,Irene Lantang and Chris Raig, and explained the reason for the visit. Staff does not have background clearance, Immediate Civil Penalty (LIC 421CG) will be issued. Approximately, around 9:55 AM new licensee, Tigran Gevorgyan, arrived and was explained for the reason of the visit. New licensee is not associated with the above facility and an application was receive from Centralized Application Bureau (CAB) for Change of Ownership (CHOW) on 8.11.2025. At 10:00 AM, with the assistance of new licensee, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 10:58 AM smoke alarms were tested and are operational. There are carbon monoxide detectors that functions properly. The fire extinguisher is located in the kitchen with a charge date of 7.16.2025. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for six (06) residents six (6) non-ambulatory resident, of which one (1) maybe bedridden, cleared for bedroom #2; hospice waiver for five (5). 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. Bedrooms: There were three (3) bedrooms designated for residents' use. Bedroom #1, bedroom #2, and bedroom #3 are shared and is used for residents only, Bedrooms were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Continue to LIC 809-C Bathrooms: The facility has two and a half (2.5) bathrooms. Bathroom #0.5 is located by the living room by the facility entrance. Hot water measured at 105.4 degrees Fahrenheit. Bathroom #1 is located by the hallway beside bedroom #1. Hot water measured at 106.1 degrees Fahrenheit. Bathroom #2 is located inside bedroom #2. Hot water measured at 113.5 degrees Fahrenheit. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. Common Areas: These included the living room and dining area for residents. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Residents dining table fits enough for six (6). In the kitchen area LPA observe a sofa for staff to rest and take a break. LPA also observe that the sofa is a sofa bed where staff stated that they sleep in. Deficiency will be cited on LIC 9099-D. Surrounding Grounds: Entry and exits were free of obstruction. The furniture were observe to be appropriate for outdoor use. The outdoor area was free of hazards. The facility does have a garage and is use for storage and laundry. Detergents and cleaning supplies are being stored in the locked garage. The facility does have a swimming pool and was observe by the LPA to be unlocked. Deficiency will be cited in LIC 9099-D. Office space is beside the entrance of the facility. Properly labeled medications were locked in the kitchen cabinets. LPA observe medications were prep in a plastic ramekin and was accessible and unlock on the kitchen counter-top beside the microwave. Deficiency will be cited in LIC 9099-D. Resident Files: LPA was not able to conduct a file review of resident records to ensure compliance of licensing forms. No files are available for LPA. Deficiency will be cited in LIC 9099-D. Staff Files: LPA was not able to conduct a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Deficiency will be cited in LIC 9099-D. Medications: No Medication and Medication Records (MMR) were able for LPA to review for proper documentation. Deficiency will be cited in LIC 9099-D. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies were observed during the visit. Exit interview conducted and a copy of the report issued.the state’s words, verbatim · CDSS document, Mar 25, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPAs) Nadia Shahbazian conducted a Pre-Licensing Inspection with the Moe Saki/Licensee and Arusyak Ohanyan/Administrator. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on December 02, 2024. A fire clearance was approved on January 21, 2025 for six (6) non-ambulatory residents, one (1) of whom may be a bedridden resident. Bedroom #2 is approved for the bedridden resident. The applicant will also be requesting a hospice waiver to retain five (5) residents. With the assistance of the administrator, a tour of the physical plant was initiated at 10:40 and the following was observed: The smoke alarms and carbon monoxide detectors are dual and inter-connected. LPA observed the detectors in each room. At 11:08am smoke and carbon monoxide detectors were tested and were observed to function properly. The facility has a brand new fire extinguisher purchased on 12/15/24. Fire extinguisher is located by the kitchen exit door. There is a ramp at the front entry and there are several exit doors which lead to the side yard. There is one (1) exit door in the kitchen, two (2) in the dining room and two (2) exits doors in the living room. The living room exit doors will be used as the main exit during emergencies. COMMON AREAS: LPA observed television, games and activities in the living room. The living room has couches, telephone/cable/internet and television. The dining area has a large dining room table and chairs to accommodate six (6) residents. OFFICE/STAFF WORKSTATION: Located by the dining room. Staff and resident files will be maintained in locked cabinets. MEDICATIONS: The medications will be kept locked in the Office/Staff workstation. LPA observed a complete First Aid Kit and the First Aid Manual in the office workstation. Continued in 809-C KITCHEN: The kitchen area that is equipped with a refrigerator, stove/oven, two (2) microwave ovens and two (2) dishwashers. There was an adequate supply of non-perishable food items and dishes. Perishable food items are not required at this time as there are no residents. Knives were observed locked in a kitchen drawer. Cleaning supplies observed locked underneath the kitchen sink. BEDROOMS: There are three (3) shared bedrooms designated for client use. Room #2 was prepared as a model room, which was furnished with two beds, 2 night stands, 2 chairs, closets, dresser drawers, bedding, linens. All bedrooms have sufficient lighting. Per STD 850, bedroom #2 is designated for the bedridden resident. BATHROOMS: The facility has two (2) bathrooms for residents' use and one (1) half bathroom for staff use. Bedroom #2 has it's own bathroom with shower. The other bathroom is located near all three bedrooms. The resident bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water in the resident bathrooms measured at 112.0 and 112.4 degrees. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have functional auditory alarms when the doors open. The backyard of the facility is large enough to hold outdoor activities. The backyard is furnished with an umbrella, table and appropriate number of chairs. LPA observed a locked/fenced swimming pool and jacuzzi in the backyard. A locked shed was also observed in the side yard. Garage: Facility has a detached garage, which will mainly be used as storage. Laundry machines, detergents and chemicals were observed locked in the detached garage, inaccessible to residents. In addition to the Pre-Licensing inspection, a Component III power point presentation was also held. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report will be provided.the state’s words, verbatim · CDSS document, Mar 11, 2025

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: ARUSYAK OHANYAN, MOE SAKI Interview Method: Telephone interview On February 13, 2025, 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, Feb 13, 2025