Winnetka Home Care

Allegation investigated: Staff refused to accept resident back at facility following hospitalization.

On 8/21/26, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted subsequent complaint visit to deliver the final report. Upon arrival, LPA met with facility Staff James Pangalila and explained the reason for the visit. During today's visit, LPA conducted physical plant tour to ensure health and safety of the residents are protected and the facility is in compliance with Title 22 Regulations. No health and safety hazards noted during the visit. During the initial complaint visit conducted by LPA Khurshudyan on 05/29/2025, LPA requested copies of pertinent information, which include but are not limited to copies of Resident’s file / documents, and other information relevant to the investigation. LPA also interviewed four (4) out of four (4) residents residing in the facility who were able to communicate and answer questions, two (2) Caregivers, the Administrator, and the Referral Agent. Continue on LIC9099-C Unsubstantiated Allegation: Staff refused to accept resident back at facility following hospitalization. To investigate this allegation, LPA Khurshudyan conducted interviews with the Administrator and Referral Agent and reviewed available documents. Records and interviews revealed that Resident 1 (R1) was admitted to the facility on 5/19/2025 after discharge from Kaiser Hospital. The following day, 5/20/25, R1 experienced a behavioral episode involving agitation, screaming, and refusal to enter the facility, creating safety concerns for R1 and other residents. Due to R1’s behavioral condition, facility staff contacted 911, and R1 was transported to Northridge Hospital Medical Center for evaluation. Interviews with the administrator and referral agent indicated that the facility did not intend to abandon R1 or terminate R1's placement. Rather, they believed R1 required further medical and behavioral evaluation by medical professionals and possible medication adjustment before safely returning to the facility. The administrator further stated that the behavioral episode raised concerns regarding whether resident 1’s existing medications were sufficient to manage R1's condition safely. The administrator also confirmed that Northridge hospital staff advised the facility that the hospital could provide prescriptions but could not dispense the requested medications because R1 was a Kaiser health care member and the prescriptions would need to be filed through Kaiser pharmacy. The administrator and referral agent denied accepting R1 back without proper medications available in hand. Furthermore, R1 was transferred to Kaiser hospital for further treatment and medication management. After R1 transferred to Kaiser hospital, one of R1's children decided not to return R1 to the facility and instead took R1 home. Interviews with residents residing in the facility confirmed they are happy with the care and supervision they receive at the facility. Based on interviews and records reviewed, there was insufficient evidence to establish that the facility intended to abandon R1. The facility requests for further evaluation and medication adjustment were related to R1’s behavior condition and safety concerns. Therefore, the allegation is Unsubstantiated at this time. No Deficiency cited during today's visit. Exit interview conducted and a copy of this report signed and deliveredthe state’s words, verbatim · CDSS document, Aug 21, 2026 · control 31-AS-20250522113258

Allegation investigated: Staff does not provide resident with clean linens. Staff does not dispose resident's trash in a timely manner. Staff does not provide resident's with nutritious meals. Staff did not deliver resident's mail in a timely manner. Staff does not ensure that the facility is free of pests. Staff does not ensure that pathways are free of hazards.

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent complaint visit to the facility to investigate the above allegation. LPA met with the facility staff designee, Isaiah Phiri, and explained the reason for the visit. To investigate the allegation on 06.11.2026, LPA Cava took a tour of the physical plant, interviewed facility staff and five (5) residents who are at the facility. On 6.29.2026, LPA requested the facility staff roster (LIC 500), resident roster (LIC 9020), resident #1 (R1) physician report, appraisal needs and service plan, admission agreement, and other documents pertaining to the investigation. Allegation: Staff does not provide resident with clean linens. Continue to LIC 9099-C. Unsubstantiated Based on interviews and observations, the licensee has ensured that staff take out trash. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Allegation: Staff does not provide resident's with nutritious meals. Regarding the allegation that staff does not ensure food is nutritious and well-balanced for residents, it was alleged that the food provided is not well-balanced and is of poor quality, LPA's record review between 9:45 AM to 10:45 AM revealed that the facility menu provides well balanced meal which includes fruit, vegetable and yogurt. Interview with residents between revealed that the food is good, nutritious and of good quality. Based on interviews and observations, facility staff has ensured that residents has a nutritious meal. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Allegation: Staff did not deliver resident's mail in a timely manner. It was alleged that staff mishandled R1's mail at the facility. Interview with staff denied the allegation, interview revealed that staff ensures to hand out all residents personal mail for the independent residents and to the responsible persons to dependent residents. LPA interviewed residents revealed that staff ensures that all residents get their personal mail. Based on the information obtained, there was insufficient evidence to confirm the allegation. Therefore, the findings is Unsubstantiated at this time. Allegation: Staff does not ensure that the facility is free of pests. It is alleged that there are pests such bugs in the facility. Interviews with the staff revealed there have not been complaints or concerns in regard to pests at the facility reported by residents. Staff did not observe pests within the facility especially in R1 bedroom. Continue to LIC 9099-C It was alleged that staff were not ensuring the residents had clean linens. LPA tour at the facility and observed resident bedrooms linen storage and laundry areas. During LPA Cava visit on 6.11.2026 and LPA Ngo-Castaneda on 6.29.2026 and 7.8.2026, it was observed that linens are available in the facility and observed R1’s and all of the residents’ beds made with generally clean sheets. No strong odors, excessive soiling, or lack of available linens were noted during the visit. On 6.29.2026 and 7.8.2026, LPA Ngo-Castaneda did not observe conditions indicating residents were routinely left without clean linens. Interview with facility staff regarding the facilities laundry and linen policy. Staff stated the facility follows a regular laundry schedule and linens are changed every week and additionally as needed when soiled. Staff reported that if a resident's bedding becomes soil due to incontinence or other circumstances staff replaced the linens promptly. Residents interviewed revealed that they received clean linens and that staff assist with changing bedding when needed. Residents reported that bedding changes regularly and more often when necessary. No residents interviewed complained of being left in soiled sheets or denied access to clean linens. Based on LPA's observations, interviews, and review of facility practices regarding laundry and linen changes there was insufficient evidence to prove that staff are not ensuring the residents have a clean linen. Therefore, the allegation is Unsubstantiated. Allegation: Staff does not dispose resident's trash in a timely manner. It was alleged that staff did not dispose R1 trash in a timely manner. On 6.29.2026 and 7.8.2026, LPA inspected R1’s room was tidy with no trash in the trash bin. During physical plant tour, LPA inspected R1’s at 8:46 AM. Interviews with residents revealed staff take out their trash every day. No residents had issues with housekeeping or trash disposal. Interview facility staff revealed they take out trash from resident rooms every morning. LPA also observed staff disposing of common area trash bins and resident room trash bins at approximately at 6.29.2026 and 7.8.2026. Continue to LIC 9099-C Interview with residents revealed they have not seen, encountered, or had any issues with pest/bed bugs in the facility. LPA Ngo-Castaneda interview with R1 on 6.29.2026 revealed that no pests is observe in their bedroom and no bug bites were observed on any of their body parts during the visit. LPA conducted an inspection of the physical plant and observed residents bedroom to be free of pest. Based on the interview and observations, there was insufficient evidence to confirm the allegation. Therefore, the findings is Unsubstantiated at this time. Allegation: Staff does not ensure that pathways are free of hazards. It was alleged that staff did not ensure that pathways are free of hazards towards the dining area. On 6.11.2026 LPA Cava observed that the pathway to the dining area is free of hazards and obstruction. On 6.29.2026 and 7.8.2026, LPA Ngo-Castaneda observe the dining area pathway to be free of obstruction. Interview with residents revealed that they have no issue or witness the dining area pathway to be obstructed and is free of hazard. Interview with staff revealed that delivery supplies for garage renovation was delivered and it was place at the dining area for a few hours and was move to garage to be installed. Based on the interview and observations, there was insufficient evidence to confirm the allegation. Therefore, the findings is Unsubstantiated at this time. Exit interview conducted, and a copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jul 8, 2026 · control 31-AS-20260602091101

Allegation investigated: Staff does not ensure facility is a comfortable temperature. Staff does not prevent resident from getting bitten by bugs. Staff does not ensure to provide hygiene products to resident in care. Facility is in disrepair. Staff does not provide activities for residents.

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent visit for the above allegation. LPA met with facility staff, Isiah Phiri (S2), and explained the reason for the visit. On 5/26/2026 at 8:50 AM, LPA Ngo-Castaneda conducted a physical plant tour and requested copies of pertinent information at 10:30 AM, which include, but are not limited to, Physician’s report, Admission Agreement, LIC 500 (staff roster), LIC 9020 (resident roster), needs and service plan, and relevant documents to the investigation. LPA interviewed the Administrator over the phone, staff designees in the facility, and five (5) of five (5) residents at 9:10 AM. Continue to LIC 9099-C Unsubstantiated Allegation: Staff does not ensure facility is a comfortable temperature. It was alleged that staff did not ensure the facility was at a comfortable temperature. During the physical plant tour, LPA observed that the wall temperature at the facility was set at 73°F. LPA interview with facility staff revealed that the facility shares a common temperature and did not receive any complaint from any resident about their room temperature because if they did, they would have adjusted the temperature to their preference. LPA interviews with residents revealed that they did not have any problem with the temperature in their respective rooms. Based on the interview and observation, there is insufficient information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Allegation: Staff does not prevent resident from getting bitten by bugs. It was alleged that the facility had bugs that bit the residents. During the facility inspection, LPA inspected all of the residents’ bedrooms and found no signs of bugs. Staff denied seeing bugs in the facility. Interviews with residents revealed that they did not see any bugs at the facility, nor did they experience being bitten by one. Based on the interview and observation, there is insufficient information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Allegation: Staff does not ensure to provide hygiene products to resident in care. It was alleged that the facility does not provide hygiene products to residents in care. During the physical plant tour, LPA observed the facility hallway lock cabinets to be fully stock of hygiene products. Interviewed staff who revealed that there is no shortage of personal or hygiene supplies. Staff informed LPA that they are always provided with a supply of shampoos, soaps, and any required items. Interviews with residents revealed that they have no issue with hygiene products, which facility staff always provide. Continue to LIC 9099-C Based on interviews and observations, the allegation is UNSUBSTANTIATED at this time. Allegation: Facility is in disrepair. Regarding the allegation that the facility is in disrepair, it was alleged that the bathroom sink drains are not working, leaving dirty water and detritus residents in the sink, leaving residents unable to wash their hands. During the physical plant tour, LPA observe and tested all bathroom sinks to be working properly. LPA interview with residents revealed that the sinks in the bathroom they use are all working. LPA interview with staff also revealed that the reported facility bathroom sinks are working, and no issue was ever raised. Based on interviews and observations, the allegation is UNSUBSTANTIATED at this time. Allegation: Staff does not provide activities for residents. It is being alleged that facility staff does not provide activities for residents. During LPA physical plant tour, LPA witnessed the activities in the living such as: books, puzzles, cards, and game boards in the living room. LPA interviewed facility staff who confirmed the activities are offered, but residents decline to do any of it. LPA interviewed residents revealed that they decline to do activities and prefer to watch television. Based on interviews and observations, the allegation is UNSUBSTANTIATED at this time. Exit interview conducted. A copy of this report issued.the state’s words, verbatim · CDSS document, Jun 29, 2026 · control 31-AS-20260518135718

Allegation investigated: Facility television is in disrepair. Staff do not ensure resident’s shower floor is not a slipping hazard.

At approximately 8:20 AM, Licensing Program Analysts (LPA), Leslie Ngo-Castaneda arrived at the facility in response to the above-mentioned allegation. LPA met with the staff designee and explained the reason for the visit. At 8:31 AM, LPA spoke with the administrator by phone regarding the reason for the visit. At approximately 8: 50 AM, LPA conducted a physical plant tour to ensure the health and safety of the residents are protected. At 8:40 AM, LPA requested copies of pertinent information, which include, but are not limited to, Physician’s report, Admission Agreement, LIC 500 (staff roster), LIC 9020 (resident roster), needs and service plan, and relevant documents to the investigation. LPA interviewed the Administrator over the phone, staff designee who are in the facility, and five (5) out of five (5) residents. Allegation: Facility television is in disrepair. Continue to LIC 9099-C Unsubstantiated Regarding the allegation, it is reported that staff did not ensure that the Wi-Fi internet was fixed in a timely manner for the television to function. An interview with the Administrator over the phone revealed that the Wi-Fi has been intermittently working in the facility for approximately a week. The administrator stated that Spectrum, the internet provider, has been contacted and visited twice, on 5/21/2026 and 5/23/2026, to resolve the matter, the internet is still intermittent. During the LPA visit, it was observed that staff designee uses their hot spots for Wi-Fi access. Interview with residents revealed that although the Wi-Fi is down, they have no concerns since if/when they ask for assistance to access the internet, it is always granted. Therefore, based on interviews and observations, this allegation is deemed unsubstantiated. Allegation: Staff do not ensure resident’s shower floor is not a slipping hazard. It was alleged that staff did not ensure the resident's shower floor was not a slipping hazard. An interview with the staff designee revealed that resident #1 (R1) wanted to use a bath towel on the floor instead of the shower mat. Interview with R1 revealed that they do not like using the shower mat and were adamant about using a bath towel on the floor. It was also revealed to LPA that R1 denied slipping/ fall in the bathroom. LPA did not observe any bruise/ injuries on R1 body. During the physical plant tour, LPA observed a shower mat, grab bars, and a shower chair available for the residents to use. An interview with residents revealed that the shower mat is always placed in front of them during the shower. Therefore, based on interviews and observations, this allegation is deemed unsubstantiated. No citation issued. Exit interview conducted. A copy of the report was provided to the staff designee.the state’s words, verbatim · CDSS document, May 26, 2026 · control 31-AS-20260521105122

Allegation investigated: Staff threatened resident. Staff did not ensure restroom was accessible to resident. Staff does not follow resident's dietary needs.

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced initial complaint visit to the facility to investigate the above allegation. LPA met with the staff designee (S2), Isaiah Phiri, and explained the reason for the visit. At 9:37 AM, facility administrator (S1), Andranik Kapikyan, arrived and was explained the reason for the visit. To investigate the allegation on 05.7.2026, LPA took a tour of the physical plant at 8:40 AM. LPA requested copies of: staff roster (LIC 500), resident roster (LIC 9020), physician report, admission agreement, appraisal, and other documents pertaining to the investigation. LPA interviewed two (2) staff and five (5) residents who were at the facility from 9:10 AM to 11:02 AM. LPA reviewed documents at 11:03 AM. Allegation: Staff threatened the resident. Continue to LIC 9099-C Unsubstantiated It was alleged that staff threatened resident #1 (R1) by stating that, ‘if he [R1] does not eat his food, then he would not eat at all’. Interviews with residents revealed that they are happy and have not experienced such treatment from facility staff. Interviews with staff revealed that they treat all their residents with respect and dignity. LPA did not observe any staff speaking inappropriately to R1 or any other residents in care. Based on interviews and observations, there is insufficient information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Allegation: Staff did not ensure restroom was accessible to the resident. It was alleged that staff failed to ensure that the restroom was accessible, which led R1 to urinate themselves. During the physical plant tour, LPA observe facility has two (2) bathrooms. Bathroom #1 is located at the end of the hallway and is accessible to all the residents. Bathroom #2 is located inside bedroom #3, where female residents reside, resident #3 (R3) and resident #4 (R4). Interview with R1 at 10:48 AM revealed that the allegation was completely false and stated that they were able to use bathroom #1 located in the hallway. Interview with residents revealed that they use the common bathroom anytime when it's not locked. Based on interviews and observations, there is insufficient information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Allegation: Staff does not follow resident's dietary needs. It was alleged that the facility did not accommodate to R1’s salt and sugar diet. Interview with the administrator (S1) and staff (S2) revealed that they accommodate to all of the residents' special diets and food restrictions. Interview with staff revealed that R1 refuses to eat the food served in the facility and would purchase ready-to-eat food from Mom’s Meals. LPA observed that lunch was served at 12:00 PM and R1 stated they refuses to eat what was served: brown rice with beef, stir-fry cabbage, and beans. R1 then requested Mom’s meal to be heated from S2, a cup of vanilla almond milk, and chocolate pudding. Interviews with four (4) residents revealed that their dietary needs are met by the facility. Residents revealed that food alternatives are offered if they dislike that food. Based on interviews and observations, there is insufficient information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Exit interview conducted, and a copy of this report signed and delivered.the state’s words, verbatim · CDSS document, May 7, 2026 · control 31-AS-20260501121812

Allegation investigated: Staff do not ensure medications are dispensed as prescribed to resident Facility is in disrepair Staff did not keep facility free of insects.

Licensing Program Analyst (LPA) Mariana Agban conducted an initial 10-day complaint visit to investigate the above allegations. At approximately 10:25 am, LPA conducted a physical plant tour. LPA requested copies of pertinent information which includes and not limited to Medications Record, Staff Roster, Resident Roster, and Resident#1(R1) Physician Report. At 11:00 Am, LPA met with Administrator Andranik Kapikyan and explained the reason for the visit. On today's visit, LPA interviewed 3 residents and attempted for 2 residents, Administrator and Staff#1(S1). Regarding Allegation: Staff do not ensure medications are dispensed as prescribed to resident It is alleged that facility staff do not administer Resident #1’s (R1) insulin as prescribed and that R1 was hospitalized twice in March due to elevated blood sugar levels. LPA conducted interview with the Administrator, who stated that R1 is able to self-administer insulin injections independently. Administrator reported that staff assist by bringing the medication to R1; however, R1 is responsible for administration. (Continue on 9099C) Unsubstantiated Administrator further stated that R1 was not hospitalized during the month of March. LPA interviewed R1, who confirmed that they self-administer insulin and utilize a continuous glucose monitoring device to track blood sugar levels.LPA reviewed R1’s Physician’s Report, which indicates that R1 is capable of managing their own medications, treatment, and related equipment. Additionally, interviews were conducted with Resident #2 (R2) and Resident #3 (R3), who denied the allegation and stated that their medications are being administered as prescribed. Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Regarding Allegation: Facility is in disrepair It is alleged that the facility is experiencing plumbing issues. LPA conducted interviews with R1, R2, Staff #1 (S1), and the Administrator. Interviews confirmed that a plumbing issue occurred at the facility during ongoing construction. The Administrator reported that a pipe burst; however, a plumber was contacted immediately and arrived within approximately 40 minutes to repair the issue. The Administrator and S1 stated that this was an isolated incident and the only plumbing issue that has occurred since construction began. During the visit, the LPA tested all bathrooms within the facility and verified that the plumbing was functioning properly at the time of inspection. LPA reviewed 5 out of 5 resident files and verified that all residents were provided with notification regarding the facility’s ongoing renovations. Based on information obtained through interviews, observations, and record review, there is insufficient evidence to support the allegation that the facility is in disrepair. Therefore, the allegation is deemed Unsubstantiated at this time. Regarding Allegation: Staff did not keep facility free of insects It is alleged that the facility has flies. LPA conducted a physical plant inspection and did not observe the presence of flies or other insects within the facility. The LPA observed that all window screens and door screens were intact and in good repair. Additionally, all sliding doors were observed to be closed during the inspection. LPA interviewed S1, who denied the allegation and stated that staff maintain the facility in a clean and sanitary condition. The Administrator reported that the facility receives routine monthly pest control services. Interviews conducted with R2 and R3 were unable to confirm the presence of flies within the facility. Based on observations and interviews conducted, there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted, copy of the report is signed by Administrator Designee and delivered.the state’s words, verbatim · CDSS document, Apr 8, 2026 · control 31-AS-20260330151508

Type of visit: Case Management - Other

In conjunction to the complaint 31-AS-20260330151508, Licensing Program Analyst (LPA) Mariana Agban conducted a Case Management visit. During the course of the investigation, LPA made the following observations: · Resident #1 (R1): There was no documentation of insulin administration recorded in the Centrally Stored Medication and Destruction Record (LIC 622). Additionally, the Administrator did not ensure that the insulin container matched the medication label, including verification of the appropriate quantity. · Resident #2 (R2): The Centrally Stored Medication and Destruction Record (LIC 622) was not up to date. Records reflected a fill date of 03/03/26; however, R2 received a new medication with a fill date of 03/30/26. · Resident #3 (R3): The Administrator reported that R3’s medication had run out and that the facility is currently awaiting a refill. · Resident #4 (R4): The Administrator reported that R4’s medication had run out and that the facility is currently awaiting a refill. · Resident #5 (R5): No medications were observed on site. The Administrator stated that R5 has been refusing to attend medical appointments and obtain medications. The LPA did not observe any medication refusal documentation at the time of the visit. The Administrator stated that the documentation would be provided promptly. LPA reviewed the facility’s Plan of Operation p.4, which states: "This facility will assist residents with their medications. This includes centrally storing medications, assisting residents with taking medications as prescribed, reordering medications as necessary, documenting refusals, and notifying the physician and family/responsible party." Based on observations, record review, and interviews conducted, the facility did not follow its Plan of Operation. An exit interview was conducted. Citations were issued. Appeal rights were provided, and a copy of this report was reviewed with and signed by the Administrator Designeethe state’s words, verbatim · CDSS document, Apr 8, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a) · Plan of correction due date: Apr 15, 2026

Plan of Operations: The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. This requirement is not met as evidenced by: Based on observations, record review, and interviews conducted, the facility did not follow its Plan of Operation. R1's had no documentation of insulin administration. R2's LIC 622 is not updated. R3 and R4 had no refill medication. R5 had documention of medication refusal. This poses a potential health, safety or personal rights risk to residents in carethe state’s words, verbatim · CDSS document, Apr 8, 2026

Plan of correction: The administrator will audit insulin for R1 and update LIC 622 for R2 as well. For R3 and R4, the Administrator will provide proof of refilled medications. For R5, the Administrator will provide the resident refusal medication form by the POC date.

Allegation investigated: Staff do not follow resident’s dietary needs. Staff speaks inappropriately to resident in care. Staff do not ensure the facility is properly maintained. Staff do not ensure residents are provided a comfortable environment.

On 3/13/2026 at approximately 9:30am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an unannounced initial visit to investigate the above allegation. Upon arrival LPA met with the Staff/Caregiver Isaiah Phiri and explained the reason for the visit. The facility Administrator Nick Kapikyan got contacted over the phone and arrived shortly after. At approximately 9:45am LPA conducted a physical plant tour to ensure health and safety of the residents are protected. At approximately 9:55am, LPA requested residents and staff rosters. Between 10:00am – 11:00am, LPA conducted interviews with the Administrator, one (1) staff/Caregivers, and four (4) out of four (4) residents residing in the facility. Continue on LIC9099-Creport narrative Unsubstantiated Allegation: Staff do not follow resident’s dietary needs. During the investigation, interviews were conducted with facility staff, the Administrator, and four (4) out of four residents regarding the allegation that staff were not following Resident #1’s (R1s) dietary needs. Staff and the Administrator reported that meals are prepared and served according to each resident’s stated preferences and requests. Staff also explained that they frequently order outside food, such as tacos or burgers when residents ask for it. According to staff, there have been multiple occasions when Resident #1 specifically requested certain meals, including outside food, and later complained about receiving the same items that had been requested. The administrator stated that staff make ongoing efforts to accommodate residents’ food preferences and denied that Resident #1’s dietary needs were being disregarded. Interviews with three additional residents indicated that they are satisfied with the meals provided at the facility. These residents reported that staff routinely ask for their meal preferences before preparing or ordering food. Based on the interviews and information gathered during the investigation, there was insufficient evidence to support the allegation that staff do not follow Resident #1’s dietary needs. Therefore, the allegation is Unsubstantiated. Allegation: Staff speaks inappropriately to resident in care. During the investigation, interviews were conducted with facility staff and residents regarding the allegation that staff speak inappropriately to residents in care. Staff denied ever speaking to residents in an inappropriate manner and stated that they always treat all residents with respect and professionalism. Three (3) out of four (4) Residents interviewed also denied the allegation. They reported that they are satisfied with the staff, feel comfortable interacting with them, and have never been spoken to in an inappropriate or disrespectful way. Based on the interviews and information gathered, there was insufficient evidence to support the allegation that staff speak inappropriately to residents. Therefore, the allegation is Unsubstantiated. Continue on LIC9099-C Allegation: Staff do not ensure the facility is properly maintained. To investigate the allegation, the LPA conducted observations of the facility and noted that the building is currently undergoing renovation. Construction activity was observed throughout the facility, consistent with improvement work in progress. The Administrator reported that residents had been informed of the renovation project in advance, including the anticipated timeline for completion. The Administrator also stated that construction is scheduled during normal daytime working hours to minimize disruption to residents during evening and nighttime hours. Interviews with residents confirmed that they were aware of the renovation work and understood that the construction was temporary. Three (3) out of four (4) Residents expressed that they were pleased the facility was being improved and stated that the renovations would result in a cleaner, nicer, and more comfortable living environment. Based on LPA's observations, resident interviews, and information obtained during the investigation, there was insufficient evidence to support the allegation that staff do not ensure the facility is properly maintained. The evidence indicates that the facility is actively undergoing renovation and that residents were informed of the temporary construction. Therefore, the allegation is Unsubstantiated. Allegation: Staff do not ensure residents are provided a comfortable environment During the investigation, interviews with staff and the administrator indicated that the ongoing renovation work is being completed to improve the facility and provide residents with a more comfortable living environment. The administrator explained that the construction is temporary and that workers are making efforts to complete the project as quickly as possible. Three (3) out of four (4) Residents interviewed confirmed that they were aware of the renovation and had been informed that temporary noise such as knocking down walls or drilling might occur during the process. Residents further stated that their bedrooms were not affected by the construction and stated the construction noise is mostly during morning time. Residents also added, the construction did not effect their daily living and expressed satisfaction with the planned improvements and stated they were looking forward to the final results. Continue on LIC9099-C Based on the interviews and information gathered during the investigation, there was insufficient evidence to support the allegation that staff failed to ensure residents were provided with a comfortable environment. The evidence shows that the renovation is temporary and that residents were informed prior to the start of construction. Therefore, the allegation is Unsubstantiated. No Deficiency issued during today's visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Mar 13, 2026 · control 31-AS-20260306081832

Allegation investigated: Staff does not ensure bathroom toilet is kept in good repair.

On 3/5/2026 at approximately 9:30am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an unannounced initial visit to investigate the above allegation. Upon arrival LPA met with the Staff/Caregiver Isaiah Phiri and explained the reason for the visit. The facility Administrator Nick Kapikyan got contacted over the phone and arrived shortly after. At approximately 9:45am LPA conducted a physical plant tour to ensure health and safety of the residents are protected. At approximately 9:55am, LPA requested residents and staff rosters. Between 10:00am – 11:00am, LPA conducted interviews with the Administrator, one (1) staff/Caregivers, and four (4) out of four (4) residents residing in the facility. Continue on LIC9099-C Unsubstantiated Allegation: Staff does not ensure bathroom toilet is kept in good repair. It was reported that staff turned the water off to one of the toilets that is located in the master bedroom and that the toilet is not operational. To investigate this allegation, LPA conducted tour of the bathroom referenced in the complaint, and other resident accessible bathrooms and observed the master bathroom toilet was operational at the time of the inspection and the second bathroom area under complete renovation. No standing waste or unsanitary condition was observed in the bathroom. During interview, the Administrator stated that as they previously reported to the Department, the facility is going under renovation and that on 2/25/2026 as part of the bathroom work, the water was shut off for approximately fifteen (15) minutes in order to complete plumbing related work. The Administrator also added that residents were informed prior to the shutoff and water service was restored immediately after the work was finished. The facility had at least one other bathroom/toilet available to residents use during the temporary interruption. Interview with the staff/Caregiver stated that the water was temporarily tuned off due to renovation work and was restored shortly after. Staff also added that all residents were informed about the water would be off briefly in master bathroom and were told that the main bathroom is available during the shutoff. Residents interviewed stated that they never experienced problems with the toilet being out of repair and added they never had lack of access to a functional toilet and did not see waste sitting in the toilet. Based on observations and interviews, there is no sufficient evidence to support the allegation. Therefore, the allegation is determined to be Unsubstantiated. No Deficiency issued during today's visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Mar 5, 2026 · control 31-AS-20260225152904

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Isaiah Phiri, and explained the reason for the visit. The administrator, Andranik Kapikyan, was notified over the telephone. At approximately 10:15am, LPA took a tour of the physical plant. The facility is a one story building. The smoke alarms and carbon monoxide are dual and interconnected. There are two fire extinguishers. One is located in the kitchen, and the other is located in at the enclosed patio area. The charge date is March 4, 2024. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Cleaning supplies were stored locked underneath the kitchen sink. Bedrooms: There are four (4) bedrooms designated for residents' use. Rooms #1 & #3 are shared. Rooms #2 & #4 are private. Room #3 has the bedridden fire clearance, per STD 850. Bedrooms were observed to be properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Bedroom #3 has it's own bathroom. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured between 109 and 114 degrees Fahrenheit. No cleaning supplies observed in either bathrooms. Common Areas: These included the living room which was equipped with living room furniture, a television, tables and chairs. There is a fireplace with a screen and a glass slide. It is non-operational, with the key stored and inaccessible to residents. No fireplace tools or fixtures present. The dining area has a large dining room table to accommodate six (6). There were no visible immediate hazards. Cleaning supplies are stored and locked in the garage. Furniture is maintained and the floors were mopped and clean. Surrounding Grounds: All entry and exit doors have a functional auditory alert. The facility backyard has sufficient yard space to hold outdoor activities. There is no swimming pool or any other bodies of water. Both side gates were checked to insure exit and passageways were clear of obstruction. Laundry area: The laundry area is located in the garage. Resident Files: Resident records are kept locked in a cabinet in the kitchen. Records were checked to insure compliance. Staff Files: Staff records are also kept locked in a cabinet in the kitchen. Records were checked to insure compliance. Medications: The medication cart is maintained in the kitchen. Medication and medication records were checked for proper storage and documentation. Garage: The garage is attached to the building. Garage is being used for laundry and storage space. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Feb 21, 2026

Allegation investigated: Staff did not ensure residents care plan was followed. Resident developed pressure injuries while in care. Staff did not follow residents dietary restrictions. Staff are operating beyond the terms and conditions of the license. Staff do not practice safe transfer methods with residents in care.

On 2/12/2026 at approximately 9:00am, Licensing Program Analysts (LPAs) Perchui Milena Khurshudyan and Mariana Agban, Licensing Program Manager Nichelle Gillyard conducted a subsequent complaint visit at this facility to conclude the investigation regarding the above allegations and to deliver the final report. Upon arrival LPAs met with the Staff/Caregiver Isaiah Phiri and explained the reason for the visit. The facility Administrator got contacted over the phone and arrived shortly after. During the initial visit conducted on 12/19/2024, at 9:30am, LPA Khurshudyan with the help of Caregiver conducted a physical plant tour to ensure health and safety of the residents are protected. At approximately 10:00am, LPA requested residents and staff rosters, copy of the facility License. LPA also requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement, Appraisal Needs and Services Plan, Staff Training, Incident Reports, and potential documents relevant to the investigation. Continue on 9099-C Unsubstantiated Between 10:05am – 11:30am, LPA reviewed six (6) residents and three (3) staff members files. LPA also conducted interviews with the Administrator, two (2) staff/Caregivers, and four (4) out of six (6) residents who were able to answer questions. During today’s visit, LPA requested copies of resident and staff rosters. At approximately 9:20am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. No immediate health and safety issues were identified. Allegation: Staff did not ensure residents care plan was followed. The Reporting Party (RP) alleged that staff did not follow the resident’s discharge instructions and did not schedule necessary follow-up care. The investigation included a review of the resident’s admission documents, care plan, discharge paperwork, and any available documentation related to follow-up appointments or coordination of care. LPA reviewed facility records to determine what actions were taken by staff to implement the resident’s care plan and discharge instructions. During the investigation, the LPA learned that the resident’s wife maintained full control over the resident’s medical appointments and care-related decisions. Interviews and documentation confirmed that the resident’s wife received the initial hospital discharge papers and informed the facility that she would personally schedule all necessary follow-up appointments. Records did not indicate that the facility was responsible for arranging these appointments once the wife assumed that responsibility. The LPA conducted interviews with the administrator, staff, and residents. Staff reported that they followed the resident’s care plan and discharge instructions to the extent applicable and stated that they deferred to the resident’s wife for follow-up scheduling per her request. Staff denied failing to implement required care plan components. Documentation reviewed did not show evidence that staff disregarded the resident’s care plan or failed to act on discharge instructions. Interviews and records indicated that any delays in follow-up scheduling were related to routine coordination processes or the resident’s wife’s control over appointment scheduling, rather than staff non-compliance. Information obtained during the investigation did not provide sufficient evidence that staff failed to implement the resident’s care plan as required. Records and interviews did not conclusively support that neglect occurred or that the facility failed to follow through with necessary care coordination. Based on the information gathered through interviews and record review, the allegation that staff did not ensure the resident’s care plan was followed is not supported by a preponderance of evidence. Therefore, the allegation is determined to be Unsubstantiated. Continue on LIC9099-C Allegation: Resident developed pressure injuries while in care. It was reported that staff failed to reposition a resident every two hours, resulting in the development of two pressure injuries. The Reporting Party (RP) alleged that one wound had healed while one remained open. The investigation included a review of the resident’s Physician’s Report (LIC 602), Needs and Services Plan, and any available skin assessments, wound care documentation, and repositioning records. The LPA reviewed and collected the repositioning log maintained by staff, which documented regular turning and repositioning consistent with the resident’s care plan and physician orders. LPA also reviewed and collected staff training records related to wound care, confirming that staff had received appropriate instruction on wound care procedures and interventions. The LPA also reviewed documentation indicating that the resident was receiving home health wound care services, including assessments and treatment by licensed wound care professionals. During the visit, the LPA was provided pictures of the resident’s healed wounds, which supported that wound care interventions had been implemented and that healing had occurred. The photographic evidence did not indicate neglect or lack of treatment. Interviews were conducted with the administrator, staff, and residents. Staff reported that the resident was repositioned routinely and that wound care instructions were followed. Staff denied missing scheduled repositioning or failing to provide required skin care interventions. No evidence was provided to confirm that staff failed to follow the resident’s repositioning schedule. Based on the information obtained, the investigation did not establish by a preponderance of evidence that facility staff failed to provide appropriate skin care or that the pressure injuries resulted from neglect. The available evidence indicated that wound care was being addressed and treated, and the investigation did not confirm that missed repositioning by staff directly caused the pressure injuries. The evidence was insufficient to prove that the facility’s actions or inactions caused the resident’s pressure injuries. Therefore, the allegation is determined to be Unsubstantiated. Allegation: Staff did not follow residents dietary restrictions. The Reporting Party (RP) alleged that the resident is lactose intolerant and that staff provided the resident with pizza and yogurt, which allegedly caused stomach discomfort. The RP did not provide a specific date for the alleged incident. During the investigation, the LPA reviewed the resident’s Physician’s Report (LIC 602) and Needs and Services Plan. Documentation confirmed that the resident has a lactose-free dietary restriction ordered by the physician. Continue on LIC9099-C The LPA conducted interviews with the administrator, staff, and residents. Staff denied providing foods inconsistent with the resident’s dietary needs and stated that meals are prepared according to physician-ordered restrictions. Residents interviewed did not report concerns regarding meals or dietary accommodation. The LPA was also provided pictures of meals served to the residents. Upon review, the photos confirmed that the meals provided were consistent with the resident’s lactose-free dietary order and did not contain dairy products. Based on interviews, record reviews, and photographic evidence, the information obtained did not verify that staff provided foods inconsistent with the resident’s documented dietary restriction. The investigation also did not confirm that the alleged meal incident occurred as reported. Because there was no corroborating evidence confirming that staff violated the resident’s dietary restrictions, the allegation is determined to be Unsubstantiated. Allegation: Staff are operating beyond the terms and conditions of the license. Licensing Program Analyst (LPA) conducted an unannounced complaint investigation visit to address the allegation that the facility was caring for three bedridden residents while the facility license permitted only one bedridden resident. During the visit, the LPA conducted a full physical walk-through of the entire facility, including all resident rooms and common areas. No residents observed met the regulatory definition of bedridden. The LPA also reviewed all resident files, including current Physician’s Reports (LIC 602) and Needs and Services Plans. Based on the documentation reviewed, no residents were designated as bedridden at the time of the visit. Additionally, the LPA conducted interviews with the administrator, staff, and residents. All individuals interviewed denied that the facility had ever admitted or cared for more than one bedridden resident at any time. The investigation further included a review of the facility’s bedridden approval and any licensing limitations related to bedridden care. Information obtained did not indicate that the facility exceeded its licensed bedridden capacity or operated outside the terms and conditions of its license. Based on the information gathered through record review, interviews, and direct observation, the allegation that the facility was operating beyond the terms and conditions of licensure could not be confirmed. Therefore, the allegation is determined to be Unsubstantiated. Continue on LIC9099-C Allegation: Staff do not practice safe transfer methods with residents in care. The Reporting Party (RP) alleged that on 12/05/2024, staff transferred a resident from bed to wheelchair by lifting the resident manually instead of using a Hoyer lift and transferring the resident to a gurney for a medical appointment. The investigation included interviews with the administrator, staff, and residents. Staff acknowledged that a Hoyer lift was not used during the transfer in question; however, all staff interviewed stated that the resident was transferred safely and no injuries or adverse outcomes were reported. The LPA reviewed staff training records, which confirmed that staff had received appropriate and current training on safe transfer techniques, including the proper use of mechanical lifts and other assistive devices. Staff confirmed knowledge of safe transfer procedures during interviews. The LPA also observed transfer equipment on site, including a Hoyer lift and other assistive devices, and reviewed facility procedures related to resident transfers. No evidence was found indicating that staff required equipment or failed to follow established transfer protocols. Although the Hoyer lift was not used, evidence supports that the resident was transferred safely, and staff had the appropriate training to perform transfers. There was insufficient evidence to establish that the alleged unsafe transfer occurred as described. Based on interviews, record reviews, and observations, the allegation that staff do not practice safe transfer methods with residents is not supported by sufficient corroborating evidence. Therefore, the allegation is determined to be Unsubstantiated. No Deficiency issues during today's visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Feb 12, 2026 · control 31-AS-20241209132029

Allegation investigated: Staff does not follow resident’s dietary needs.

On 2/12/2026 at approximately 9:00am, Licensing Program Analysts (LPAs) Perchui Milena Khurshudyan and Mariana Agban, Licensing Program Manager Nichelle Gillyard conducted an unannounced visit to investigation into the above allegation. Upon arrival LPAs met with the Staff/Caregiver Isaiah Phiri and explained the reason for the visit. The facility Administrator got contacted over the phone and arrived shortly after. At approximately 9:15am LPAs conducted a physical plant tour. At approximately 9:25am, LPA requested residents and staff rosters. LPA also requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement, Appraisal Needs and Services Plan, and potential documents relevant to the investigation. Between 9:30am – 11:45am, LPA reviewed four (4) residents files. LPA also conducted interviews with the Administrator, one (1) staff/Caregivers, and two (2) out of four (4) residents who were able to answer questions. Continue on LIC9099-C Substantiated Allegation: Staff does not follow resident’s dietary needs. It was reported that staff are providing fried food. RP stated dietitian, RP cannot have fried food. To investigate this allegation LPA conducted a review of Residents files, interviewing staff and residents, and observing meal service during the visit. LPA reviewed R1’s Physician Report LIC602A signed by the physician and dated on 1/27/26, which indicated that R1 has a diagnosis of diabetes and requires a restricted diet consistent with diabetic dietary guidelines. During the visit, LPA observed the breakfast served to R1. The meal consisted of scrambled eggs mixed with spicy pork Mexican sausage, yogurt, white bread, and coffee. Although the portion size was adequate, the meal was high in sodium and included items not appropriate for a diabetic or restricted diet, specifically the spicy pork sausage and white bread. LPA interviewed one (1) caregiver, who stated he/she was not fully aware of R1’s dietary requirements and generally prepared meals without customized dietary needs. LPA attempted to interview four (4) residents. Two (2) out of four (4) residents (R1 and R2) who agreed to answer questions, reported no concerns with food portions. However, R1 stated that staff do not ask for meal preferences and typically serve whatever is prepared, without regard to dietary restrictions. LPA also interviewed the administrator, who confirmed that the facility maintains a sufficient supply of food. LPA suggested Administrator to review all residents' files/records and follow dietician orders. Based on record review, observation, staff and resident interviews, and the administrator’s statements, there is sufficient evidence to support the allegation that staff does not follow residents’ dietary needs. Therefore, the allegation is Substantiated. A Deficiency is being cited on the LIC9099D. Exit interview conducted and copy of this report signed and delivered. Allegation: Staff does not provide nutritious meals for resident. It was reported that staff does not provide nutritious meals for residents. To investigate the allegation, LPAs conducted interviews with staff, the administrator, and two (2) out of four (4) residents who agreed to be interviewed. LPA also conducted a tour of the facility and observed meal service. During interviews, one (1) of the two (2) residents interviewed (R2) stated that he/she had no complaints or concerns regarding the meals and believed the food provided was nutritious. Resident 1 (R1) reported that meals were not nutritious and stated that no fresh fruits or vegetables were provided. To further investigate the allegation, LPA conducted a tour of the kitchen and food storage areas. LPA observed that the facility had a fully stocked supply of food, including sufficient quantities of perishable and non-perishable items. LPA also observed the breakfast served to R1 during the visit. Although the meal provided was not what R1 requested, it was observed to have an adequate portion size and appeared nutritious. Interview with staff indicated that the facility consistently maintains sufficient food supplies and that meals are prepared daily. Based on interviews and observations, there is insufficient evidence to support the allegation that staff do not provide nutritious meals for residents. Therefore, the allegation is deemed Unsubstantiated. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Feb 12, 2026 · control 31-AS-20260211145326

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(7) · Plan of correction due date: Feb 20, 2026

General Food Services...(b)The following food service requirements shall apply:(7)Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement is not met as evidenced by: Based on observation and interview, one out of four Residents R1 with diabetes was served the regular meal plan which contains high sodium and sugar. This confirmed that R1 was not on a special diet plan. This poses a potential health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: The administrator has agreed to follow special diet plan for residents require special diet plan and will provide copy of training materials provided to all staff/caregivers regarding food services and special diets.

Allegation investigated: Staff did not prevent smoke from entering the facility. Staff did not keep facility free of insects. Staff does not maintain a comfortable temperature for residents in care.

At 9:00 Am, Licensing Program Analysts (LPAs) Mariana Agban and Perchui Milena Khurshudyan and Licensing Program Manager (LPM) Nichelle Gillyard conducted an initial 10-day complaint visit to investigate the above allegations. At approximately 09:05am, LPAs and LPM conducted a physical plant tour. LPAs requested copies of pertinent information which includes and not limited to Residents files, Staff Roster, Resident Roster. At 9:40 Am, LPAs and LPM met with Administrator Nick Kapikyan and explained the reason for the visit. Between 9:00- 10:15, LPAs and LPM interviwed 2 resdidents, attempted interview two other residents and the Administrator. Allegation: Staff did not prevent smoke from entering the facility. It was alleged that staff leave the facility door open while residents smoke outside, allowing smoke to enter the facility. During the physical plant tour, LPA observed two residents smoking in the backyard while the sliding glass door remained open, which allowed smoke to enter the interior of the facility. Interview with Resident #1 (R1) revealed that staff are often occupied and do not consistently close the door when the two residents are smoking.(Continued on LIC 9099-C) Substantiated Based on LPA’s observations and interviews conducted, the allegation is deemed Unsubstantiated at this time. Allegation: Staff are not serving an adequate amount of food portions to a resident in care it was alleged that facility staff served only a banana as breakfast to a resident. During the physical plant tour, LPAs and LPM observed that one resident was served eggs, pork chorizo, yogurt, and bread for breakfast. Additionally, LPAs observed that the facility maintained a sufficient supply of both perishable and non-perishable food items properly stored, including eggs, yogurt, frozen meats, fruits, and vegetables. Interviews confirmed 1 out of 4 residents state that food portions provided at the facility are adequate. Two of the 4 residents did not want to be interviewed. Based on LPA’s observations and interviews conducted, the allegation is deemed Unsubstantiated. Allegation: Staff did not prevent a resident from using foul language towards another resident in care. It was alleged that a resident used inappropriate language within the facility. Interview with 1 out of 4 residents denied the allegation and stated that they had not witnessed any resident using inappropriate language. LPA and LPM attempted to interview 2 out of 4 residents; however, both residents declined to be interviewed. Based on the information obtained, there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted, copy of this report signed and delivered. Based on LPA’s observations and the interview conducted with R1, the allegation is deemed Substantiated at this time. Allegation: Staff did not keep facility free of insects. It was alleged that flies were entering residents’ rooms. During the physical plant tour, LPM/LPA observed screen window and screen doors to be in good repair. LPA and LPM observed a large mosquito and a large black gnat insect on the wall in Room #4. LPM observed the sliding door in room #4 to be open cracked letting insect in. Staff was busy with other tasks and did not observed or close the door to keep the room free from insects. LPA/LPM interviewed R1 who confirmed the allegation. R1 stated that backyard doors are frequently left open, allowing insects to enter the facility. Even though the administrator contracts monthly with a pest control company it is staff's responsibility to make sure screen doors and the sliding doors are maintained closed to keep the facility free from insects. Based on LPA’s observations and interviews conducted, the allegation is deemed Substantiated at this time. Allegation: Staff does not maintain a comfortable temperature for residents in care It was alleged that staff maintain the facility at a cold temperature. During the physical plant tour, LPAs and LPM observed that the NEST thermostat was turned off. The temperature in the common areas measured 65°F, and resident rooms measured approximately 67°F. Interview with R1 confirmed the allegation, stating that residents were required to wear additional layers due to the low temperature. The Administrator stated that it is challenging to adjust the temperature to accommodate everyone’s preference simultaneously. Based on LPA’s observations and interviews conducted, the allegation is deemed Substantiated at this time. Exit interview conducted, citations issued, appeal right given and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Feb 12, 2026 · control 31-AS-20260204112256

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Feb 17, 2026

Personal Rights(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations.. This requirement is not met as evidenced by; Based on observations and interview, LPAs and LPM observed two residents smoking in the backyard while the sliding glass door remained open, which allowed smoke to enter the interior of the facility. Staff did not close the door. This poses potential risk to the personal rights of the residents in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Administrator agreed to provide plan to avoid smoke enter the interior of the facility by the POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Feb 17, 2026

Maintenance and Operations The facility shall be clean, safe, sanitary... 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; Based on observations and interview, LPM and LPA observed a mosquito and a large black insect on the wall in Room #4. Staff did not make sure the door was closed.This poses potential risk to the personal rights of the residents in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Administrator agreed to provide proof of pest control services by the POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(b) · Plan of correction due date: Feb 17, 2026

Maintenance and Operation(b) A comfortable temperature for residents shall be maintained at all times.This requirement is not met as evidenced by; Based on observations and interview, LPAs and LPM that the thermostat was turned off. The temperature in the common areas measured 65°F, and resident rooms measured approximately 67°F. This poses potential risk to the personal rights of the residents in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Administrator agreed to provide a plan to keep comfortable temperature for residents by the POC date.

Type of visit: Office

Licensing Program Manager (LPM) Nichelle Gillyard and Licensing Program Analyst (LPA) Perchui Melina Khurshudyan met with Administrator/President Alla Harutunyan for an informal office visit. The purpose of the office visit is to discuss the current operation of this facility and to clarify requirements. On 08-06-2025 LPA Khurshudyan conducted a case management visit to do a wellness check on a recent resident that was admitted. During the visit LPA was made aware that the facility had been sold. The department did not receive a letter of intent to sale which will result in the issuance of a new license, per health and safety code 1569.191. LPA completed a CCL file review and contacted the county assessor’s office. LPA found that in June 2025 the property was sold. The Administrator did not notify the department nor submit a lease-back agreement with the new property owner until the LPA addressed it with Mrs. Harutunyan. During the Informal Meeting, Licensing Program Manager (LPM) Nichelle Gillyard reminded current Licensee/Administrator Mrs. Harutunyan that until the new CHOW – Change of Ownership application process is complete, and a new license is issued, the current licensee/administrator retains full responsibility for the operation of the facility. This includes ensuring compliance with all applicable laws and regulations. Copy of Health and Safety Code 1569.191 was provided to the Licensee/Administrator. Continue on LIC809-C According to the Administrator/President there was intent to sell. She is trying out potential owner as staff to see if they would be a fit. During the meeting a letter of intent was submitted. She will notify LPA if she decides not to go through with it. The administrator was very apologetic and didn't realize the requirements to notify for intent to sell. Also during the visit we discussed criminal record clearance. Two staff were not associated to the facility. LPA collected documentation for Mr. Kapikyan. The department will submit for association. Documentation for the other staff will be submitted today. LPM reminded the Administrator that staff shall not have presence or work in a facility until fingerprint cleared and associated. LPA collected a copy of the new lease which will be added to the folder. Licensing Program Analyst (LPA) Perchui Milena Khurshudyan requested and collected the following document: New lease agreement between the Licensee and the new owner of the property. Intent to Sell letter issued for the Dept. of Social Services – CCL, and for residents currently residing at the facility. LIC9182 - for the new Staff/Caregivers Licensee will email copies to LPA. Copies of IDs for the new Staff/Caregivers. Exit interview conducted copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Aug 13, 2025

Type of visit: Case Management - Other

ON 8/6/2025 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted a Case Management visit at the above facility to verify that Resident #1 (R1) relocated to the facility on 8/5/2025, and to confirm that R1 is doing well following the transition. Upon arrival LPA met with the Caregiver Isaiah Phiri and explained the reason for the visit. Entrance interview conducted. Facility Co-Administrator Andranik Nick Kapikyan arrived shortly after. At approximately 12:45pm LPA requested facility staff and clients’ rosters. During today’s visit, LPA conducted a physical plant tour at the facility to ensure health and safety of the residents are protected. LPA requested to confirm R1’s identity and well-being. During the physical plant tour, LPA checked R1’s private room and observed R1 on wheelchair resting in their room. A brief interview was conducted with R1. R1 appeared alert and oriented to place and time. R1 expressed that the move was smooth and reported feeling comfortable in the new facility. No signs of distress were observed during the visit. To confirm R1’s identity, LPA verified R1’s name and date of birth with both the resident and facility records. Based on LPA’s observation and brief interview, R1 appears to be adjusting well and had no concerns or complaints. During today's visit LPA collected the following documents: LIC500 LIC9020 No deficiencies were observed during this visit. Exit interview conducted with the Administrator. A copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Aug 6, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan met with Administrator Alla Harutyunyan for a One (1) Year Required visit for this facility. LPA informed the Administrator the purpose of the visit. There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation and Infection Plan. Signs to wear a mask and other Covid 19 prevention protocol signs were posted indoors. Hand washing coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. A tour of the physical plant was conducted with staff Leonisa Balsomo at 3:28 PM. The facility is a single storey building with four (4) bedrooms and two (2) bathrooms currently occupying five (5) residents. The facility is fire cleared for six (6) non-ambulatory residents, one (1) of which may be bedridden on Room 3. Hospice waiver for two (2) residents. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with dining area. The facility maintains a comfortable temperature at 74°F. The smoke detectors are hardwired and interconnected and observed to be operational. The fire extinguishers were filled and last inspected on 06/21/24. There is a carbon monoxide detector installed at the facility. (continued on LIC 809-C) The backyard of the facility has outdoor furniture, with a covered shaded area for clients. The front and backyard passageways were clear of any obstruction. There is no body of water in the facility. The backyard has a twenty (20) footer trailer being used as miscellaneous storage. The garage was converted into an additional dwelling unit (ADU) and currently being used as office, staff bedroom, frozen food storage and laundry area. There is no access to the staff house from inside the facility. Laundry detergent and other cleaning agent is locked in the garage. There is no body of water in the facility. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be kept in a locked drawer in the kitchen. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 115.9°F to 118.5°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the linen cabinet. Medications: LPA observed medication are kept in a medication cart located in the kitchen. The cart was observed to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. First aids kits have complete tools and supplies. Client records: Client records are reviewed and appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff record. Staff records appeared to be complete and updated. Disaster drill was last conducted on 11/01/2024. Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Nov 22, 2024

Type of visit: Required - 1 Year

A Required One (1) year - Annual visit was conducted today by Licensing Program Analyst (LPA) Rosaura Valenzuela. LPA met with Administrator Alla Harutunyan and explained the purpose of the visit. LPA observed that five (05) residents were at the facility during visit. A tour of the physical plant was conducted at 12:30 PM and the following was noted: The front main door is the only entrance being utilized at the facility. The facility is a single story home with four (5) client bedrooms and two (2) bathrooms. There is no body water in the facility. Bedrooms were toured and observed to be clean and properly furnished. Linen storage was also checked and observed to have ample supply of clean linen and towels. Bathrooms were observed to be clean and sanitary with necessary supplies. Hot water temperature measured at a range of 105.6°F to 120.0°F and within the required range. Physical plant was checked for cleanliness and condition. Facility was in good repair and observed to be clean and free of clutter during today's visit. Living and dining room furniture were also checked for functionality (wear and tear). Furniture was observed to be in good condition. Kitchen area was observed to be clean and sanitary. All the toxins, cleaning solutions and disinfectants are locked inside the garage. Knives and sharps are kept locked underneath the kitchen sink. Food. The facility is observed to have sufficient food supply for the clients both perishable and non-perishable. Temperature of facility wall thermostat is set at 73.0°F and observed to be within the required range. Fire extinguishers. The facility has two (02) fire extinguishers which were serviced on 06/23. Carbon monoxide and smoke alarms are hardwired and interconnected, tested and observed to be operable. Garage is attached to the house and toxic chemicals are stored there. The laundry room is also located there. Garage was observed to be locked and inaccessible to residents. The garage is also used as a storage for PPE and other supplies. Client records were reviewed for current Needs and Service plans, physician report, admission agreements, etc. Client records appeared to be complete and current. Medication was observed to be inaccessible to residents and stored in a secured cabinet located in the kitchen. There is a complete First Aid kit. Staff records were reviewed. Staff present records were observed to be current and updated. No health and safety issues were noted at the time of this visit. Exit interview conducted and a copy of this report was given.the state’s words, verbatim · CDSS document, Oct 29, 2023