Wisdom Willow Senior Living

Allegation investigated: Due to neglect and lack of supervision, resident sustained injuries

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced subsequent complaint investigation visit at the facility at 02:52 PM. LPA met with facility staff who contacted the Administrator Lousine Sarkisian. The Administrator arrived to the facility at 03:08 PM. Entrance interview was conducted and the reason for the visit was explained. On 02/24/2026 the Woodland Hills North Adult and Senior Care Regional Office (RO) received a complaint which alleged that due to neglect and lack of supervision Resident #1 (R1) sustained injuries. The complaint was investigated by the Department. CONTINUED ON LIC 9099C. Substantiated On 02/25/2026 LPA Byrne initiated the investigation and conducted a brief physical plant tour, collected copies of pertinent documentation, and conducted interviews with two (2) residents, the Administrator, and one (1) staff. During the course of the investigation, the Department subpoenaed medical records and the police report related to this incident. On 03/12/2026 an Investigator conducted interviews with the Administrator, Resident #2 (R2), Resident #3 (R3), Resident #4 (R4), and Staff #1 (S1). Additionally, interviews were conducted on 05/06/2026 with Witness #1 (W1), and on 05/21/2026 with Staff #2 (S2). During today’s visit LPA delivered findings and interviewed the Administrator between approximately 02:59 PM and 04:30 PM. The allegation of “Due to neglect and lack of supervision, resident sustained injuries” alleges that R1 sustained facial bruising and a cut on their nose due to neglect and a lack of staff supervision. Interviews with the Administrator revealed R1 arrived at the facility on 02/18/2026 around 7:00 PM with only two (2) of their prescribed medications. The Administrator stated the Licensee Representative and the family member of R1 arranged placement of R1 at the facility without their knowledge. When R1 arrived initially they did not want to leave the ambulance and were yelling and screaming although R1’s family member (Witness #1) came to the facility and was able to calm R1 down. The Administrator stated during their stay, R1 expressed behavioral disturbances including screaming, attempting to get out of bed, and slamming themselves on the floor. The Administrator stated on 02/20/2026 they were informed by staff that R1 was screaming again and had woken up with discoloration around their eye after suffering a fall earlier around 4:00 AM. The Administrator stated they were informed of the injury around 8:00 AM. The Administrator provided a photo of the resident reflecting a bruised eye taken on 02/20/2026 at 9:04 AM. The Administrator stated that R1 was transferred to the hospital due to requiring a higher level of care than the facility was able to provide and medical attention. The Administrator denied any neglect or abuse by staff or any residents. They also denied R1 having a fall in the shower. The Administrator stated a pre-placement appraisal was not conducted prior to accepting the resident nor did the resident arrive with a medical assessment completed by a medical professional indicating the resident was appropriate for assisted living. CONTINUED ON LIC 9099C. The interview with S1 revealed that on the day of the incident S2 had informed S1 that R1 had suffered a fall earlier in the morning at approximately 04:00 AM. S1 stated they were instructed by S2 to sit in a chair at R1’s bedside to assist R1 when they woke up. S1 stated that at approximately 05:00 AM R1 woke up, saw S1 sitting in the chair near their bed, attempted to get out of bed, lost their balance, fell forward, became aggressive, threw objects and their walker towards S1. S1 stated that they photographed R1’s injuries that they sustained at approximately 05:00 AM and sent them to the Administrator although S1 no longer had the photo. S1 denied any physical altercations between R1 and staff or residents and denied neglecting any residents. The interview with S2 revealed that R1 had woken up at approximately 04:00 AM and had requested milk. S2 went to get milk from the kitchen and as they were coming back to the bedroom, they heard a noise and saw R1 on the floor, holding their eye. S2 asked S1 what had occurred and was informed that R1 attempted to get out of bed and fell to the floor. S2 asked R1 if they wanted to go to the hospital and R1 denied medical attention. S2 stated that at 05:00 AM, R1 woke with a black eye. S2 stated that they contacted the facility Administrator and informed them of what had occurred. S2 stated that the Administrator made the decision to transfer R1 to the hospital. S2 denied R1 being in a physical altercation with their peers or falling in the shower. S2 stated R1 required a higher level of supervision and care, possibly 1:1 care which the facility could not provide. Interview with W1 revealed that R1 had been admitted to the facility but only resided there for three (3) days before suffering the injury and being transported to the hospital. W1 did not know exactly what happened at the facility when R1 was injured. W1 recalled they had visited the facility to drop off clothing when they were informed that R1 had become very aggressive and was involved in an altercation with another resident. The facility informed W1 that R1 had assaulted the other resident and caused a “black eye,” which subsequently led to R1 being transferred to the hospital. W1 asked if R1 was hurt and facility staff said R1 did not sustain any injury. W1 stated they were contacted by the hospital and informed that R1 had sustained a facial injury at the facility. W1 stated when visiting R1 at the hospital the hospital informed W1 that R1 informed them they fell in the shower and hit their face when left alone. Although, W1 theorized that R1 may be confused. W1 denied being notified by the facility of R1’s hospitalization and only learned that R1 had been transferred after making the unannounced visit. W1 questioned the Administrator why they were not notified, and the Administrator said the incident occurred during the night/early hour which W1 understood. However, it was 2:00 PM when W1 arrived at the facility. CONTINUED ON LIC 9099C. Interviews with two residents (Resident #2 and #3) revealed no issues or concerns regarding the facility. An interview with R1’s roommate, Resident #4 (R4) was attempted but R4 had limited communication skills. The review of medical records for R1 revealed that R1 was admitted to the emergency room with the chief complaint of a fall and facial trauma on 02/20/2026 at 12:01 PM. The medical records indicated that R1 was admitted with the facial injury as a result of R1 engaging in a physical altercation with another resident of the facility. Upon admission R1 reported that the injury occurred as a result of slipping and falling in the shower the previous night. Medical records reflect that R1 had a diagnosis of Alzheimer’s. A review of the Unusual Incent/Injury Report (LIC 624) submitted by the Administrator revealed on 02/20/2026, R1 sustained a fall from their bed at approximately 4:15 AM injuring their left upper eyebrow. The report indicated they provide night supervision but do not provide 1:1 care at night and R1 was taken to the emergency room for placement. The incident was reported to the hospital social worker where the resident came from, and they advised taking R1 to the closest emergency room. The 02/20/2026 police report was also reviewed. Based on the information obtained during interviews and record review there is sufficient evidence to support the allegation of “Due to neglect and lack of supervision, resident sustained injuries.” R1 was accepted into the facility without a pre-admission appraisal or medical assessment therefore R1’s care needs were not identified prior to being admitted resulting in neglect and the subsequent fall R1 sustained. Staff also reported the fall occurred around 4:00 AM but hospital records show that R1 did not receive medical attention at the hospital until approximately 12:00 PM. Therefore, the allegation is deemed Substantiated at this time. LPA informed the Administrator that an immediate civil penalty in the amount of $500 is being assessed on today’s date (07/27/2026) for a violation that resulted in the injury or illness of an individual in care. The Administrator was also informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and/or 1569.49(f). The following deficiency and civil penalty were cited/assessed (refer to LIC 9099Ds). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.the state’s words, verbatim · CDSS document, Jul 27, 2026 · control 29-AS-20260224084559

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87461(f)(1) · Plan of correction due date: Jul 28, 2026

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interviews and record review the Licensee did not comply with the section cited above as R1 sustained a facial injury while under the care of the facility which posed an immediate health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Jul 27, 2026

Plan of correction: Administrator agreed to conduct an in-service training with facility staff which covers the expectations of facility staff when providing care and supervision to residents and what constitutes appropriate care and supervision of residents. Additionally, the Administrator... ...agreed to submit a statement signed by the Licensee Representative which confirms that the Licensee Representative will involve the Administrator in pre-assessments of all future residents prior to their acceptance into care at the facility. Administrator agreed to submit the POC no later than POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced case management - deficiencies visit at the facility at 02:52 PM. LPA met with facility staff who contacted the Administrator Lousine Sarkisian. The Administrator arrived to the facility at 03:08 PM. Entrance interview was conducted and the reason for the visit was explained. During an investigation into a complaint at the facility Witness #1 (W1) was interviewed and revealed that Resident #1 (R1) had been admitted to the facility but only resided there for three (3) days before suffering an injury and being transported to the hospital. W1 recalled that they had visited the facility to drop off clothing when they were informed that R1 had become very aggressive and was involved in an altercation with another resident. The facility informed W1 that R1 had assaulted another resident which subsequently led to R1 being transferred to the hospital. W1 asked if R1 was hurt and facility staff said R1 did not sustain any injury. W1 stated they were contacted by the hospital and informed that R1 had sustained a facial injury at the facility. W1 denied being notified by the facility of R1’s hospitalization and only learned that R1 had been transferred after making the unannounced visit. W1 questioned the Administrator why they were not notified, and the Administrator said the incident occurred during the night/early hour which W1 understood. However, it was 2:00 PM when W1 arrived at the facility. LPA informed the Administrator that resident’s representatives shall be regularly informed by the Licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs and W1 should have been informed of R1’s hospitalization as a result of sustaining an injury at the facility. The following deficiency was cited (refer to LIC 809D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.the state’s words, verbatim · CDSS document, Jul 27, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(8) · Plan of correction due date: Aug 10, 2026

87468.1 Personal Rights of Residents in All Facilities (a) ...shall have...personal rights: (8) To have their representatives regularly informed by the licensee... This requirement is not met as evidenced by: Based on interviews the Licensee did not comply with the section cited above as R1's responsible party was not notified of their hospitalization which poses a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jul 27, 2026

Plan of correction: Administrator agreed to submit a signed statement of understanding confirming that they will notify resident's responsible parties of any emergencies/hospitalizations within a timely manner. Administrator agreed to submit the signed statement to CCLD no later than POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 09:31 AM. LPA met with facility staff who contacted facility Administrator Lousine Sarkisian via telephone call. The facility Administrator arrived to the facility at 09:45 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:48 AM, the LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: This included the living room, dining room, and hallways. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contained a couch, a television, activities for resident use, emergency water supplies, and a locked cabinet which contained facility files. LPA observed all required postings for the facility located on the living room and dining room walls. The dining room was observed to be clean and contained adequate seating for resident use. The hallway was observed to be clear from obstructions. The hallway contained storage for linens and locked storage for resident medications. Combination fire and carbon monoxide alarms along with facility fire doors were tested at 12:50 PM and were functional at the time of the visit. CONTINUED ON LIC 809C. KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer which contained knives and other sharp objects. LPA observed unsecured supplements and Claritin in a kitchen drawer. LPA notified the Administrator who immediately secured the items. LPA observed three (3) expired cans of tomatoes and three (3) expired juice bottles. LPA notified the Administrator who immediately discarded the items. LPA observed a wall mounted fire extinguisher that was last purchased on 05/28/2025 which is outside of the required timeframe. LPA informed the Administrator that they were recently cited for a violation of Health and Safety Code (HSC) 1569.149 on 02/26/2026. LPA informed the Administrator that because this is a repeat violation within a twelve (12) month period a civil penalty in the amount of $250 is being assessed on today’s date (06/30/2026). BEDROOMS: There are four (4) bedrooms in the facility. LPA and facility Administrator toured all four (4) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #3 contained a direct exit to the outdoors of the facility. BATHROOMS: There are three (3) bathrooms at the facility. One (1) bathroom is designated as shared resident bathroom, one (1) is a private resident bathroom, and one (1) is designated as a staff bathroom. All bathrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets. All grab bars observed were properly secured. The water temperature was measured to be between 108.9 and 112.5 degrees Fahrenheit, which is within the range required by regulation. OUTDOOR SPACE: The facility had one (1) emergency exit gate located in the front yard. All railings located at the facility were secured properly. LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed the backyard to contain two (2) sheds which contained additional cleaning supplies and the facility’s washer and dryer. LPA observed unsecured bottles including cleaning chemicals and pesticides. LPA notified the Administrator who immediately secured the items. LPA informed the Administrator that they were recently cited for a violation of California Code of Regulations (CCR) 87309(a) on 02/26/2026. LPA informed the Administrator that because this is a repeat violation within a twelve (12) month period a civil penalty in the amount of $250 is being assessed on today’s date (06/30/2026). CONTINUED ON LIC 809C. RECORD REVIEW: Record review began at 10:43 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Four (4) staff files were reviewed. All staff files contained all required documentation and signatures. Six (6) resident files were reviewed. Two (2) resident files were missing Appraisal Needs and Services plans and one (1) resident file contained an appraisal that was completed more than 12 months prior. LPA informed the Administrator that appraisals shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first. LPA observed one (1) resident file to be missing proof of a negative Tuberculosis (TB) test. MEDICATION REVIEW: Medication review began at 12:12 PM. Medications for three (3) of six (6) residents were observed. All medications were stored properly. No medications observed had logged start dates for the medications. Two (2) medications had inaccurately logged quantities and dosages (Strength) of the medications. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted in May. The facility’s emergency disaster plan is up to date and is accurate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that the staff treat them well and are attentive to their needs. LPA interviewed one (1) staff member with the assistance of the Administrator acting as a translator. The staff member interviewed was knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, emergency disaster plan, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited and civil penalties were assessed (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 30, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Trevor Byrne conducted a case management - deficiencies visit at the facility today. LPA arrived to the facility at 10:15 AM. LPA met with facility staff who contacted the Administrator Lousine Sarkisian via telephone call. The Administrator arrived to the facility at 10:27 AM. Entrance interview conducted and the reason for the visit was explained. During today’s visit, the LPA conducted a brief physical plant tour, collected copies of documentation, and conducted interviews with two (2) residents, the Administrator, and one (1) staff between approximately 10:28 AM and 04:30 PM. During the physical plant tour LPA observed a shed located on the side of the house. The shed was observed be unlocked with a key placed into the lock left unattended. LPA observed this shed to contain various cleaning chemicals. LPA informed the Administrator that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. The Administrator expressed understanding and secured the chemicals at the time of the visit. LPA observed bedroom #3’s direct emergency exit to be blocked by a chair. Additionally LPA observed the facility’s front door to contain a deadbolt with a key lock on both sides of the door. LPA observed this deadbolt to be locked at the time of the inspection. LPA informed the Administrator that the facility does not have the appropriate fire clearance to lock doors leading to the exterior of the facility nor did the facility notify Community Care Licensing Division of their intent to lock exterior doors. LPA informed the Administrator that this constitutes a violation of the facility’s fire clearance and that this is a zero tolerance violation. LPA informed the Administrator that an immediate civil penalty in the amount of $500 is being assessed on today’s date (02/25/2026) for a violation of the facility’s fire clearance. Continued on LIC 809C. The Administrator expressed understanding, removed the chair from bedroom #3’s exit door, and installed a standard deadbolt on the facility’s front door at the time of the visit. During the physical plant tour LPA observed Staff #1 (S1) working at the facility providing care and supervision to the residents. LPA was informed by the Administrator that S1 had worked for the facility since 07/02/2025. LPA reviewed the list of individuals associated to the facility and did not observe S1 associated to the facility. LPA informed the Administrator that all individuals subject to a criminal record review shall obtain a criminal record clearance and be associated to the facility prior to working, residing or volunteering in a licensed facility. LPA informed the Administrator that not having S1 associated to the facility would result in the assessment of a Background Check Civil Penalty (BCCP) in the amount of $100/day per employee for a maximum of five (5) days for the first offense. LPA stated that a civil penalty in the amount of $500 is being assessed on today’s date (02/25/2026) for S1 not being associated to the facility. The Administrator expressed understanding and agreed to associate S1 to the facility. During record review LPA observed an incident that occurred with Resident #1 (R1) on 02/20/2026. LPA interviewed the Administrator who stated that R1 arrived to the facility on 02/18/2026 and was discharged back to the hospital on 02/20/2026. The Administrator informed LPA that no preadmission appraisal of R1 was conducted and no physician’s report for R1 was obtained prior to R1 entering the facility. LPA informed the Administrator that prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs. Additionally, LPA stated that prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year. The Administrator expressed understanding and confirmed that they were aware of these requirements. The Administrator stated that R1 would not be returning to the facility but agreed to submit a statement of understanding confirming that they are aware of, and will complete, all required pre-admission documentation prior to accepting residents into the facility. Pursuant to Title 22 California Code of Regulations the following deficiencies were cited and civil penalties were assessed. Exit interview conducted, report was reviewed, and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 25, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.149 · Plan of correction due date: Feb 26, 2026

§1569.149 Fire clearance... ... the facility shall secure and maintain a fire clearance... This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as an emergency exit was blocked by a chair at the time and the facility had a front door that was locked via key/deadbolt from the inside of the facility which poses an immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 25, 2026

Plan of correction: Administrator swapped the double keyed deadbolt for a standard deadbolt at the time of the visit. Administrator removed the chair at the time of inspection. POC cleared.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Feb 26, 2026

87309 Storage Space and Access (a)... the licensee shall ensure that disinfectants, cleaning solutions...and other similar items..are in locked storage and are not left unattended.. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as the outdoor storage closet was full of cleaning supplies was left unlocked and unattended with the key left in the lock which poses an immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 25, 2026

Plan of correction: Administrator agreed to train staff on the importance of locking chemicals up and placing the key for the storage in a secure location where residents do not have access. Administrator agreed to submit proof of training to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87355(b) · Plan of correction due date: Mar 11, 2026

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as S1 had finger print clearance but was not associated to the facility which poses a potential safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 25, 2026

Plan of correction: Administrator agreed to associate S1 to the facility and to send proof of association to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87457(c)(1) · Plan of correction due date: Mar 11, 2026

87457 Pre-Admission Appraisal (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed... (1) The appraisal shall document, at a minimum: This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as R1 did not have a pre-admission appraisal completed prior to their acceptance as a resident to the facility which poses a potential safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 25, 2026

Plan of correction: The Administrator agreed to submit a statement of understanding confirming that they are aware of, and will complete, all required pre-admission documentation prior to accepting residents into the facility. Administrator agreed to sign this statement along with the Owner of the facility and to submit this statement to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Mar 11, 2026

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment... This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as R1 did not have a medical assessment completed prior to their acceptance as a resident to the facility which poses a potential safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 25, 2026

Plan of correction: The Administrator agreed to submit a statement of understanding confirming that they are aware of, and will complete, all required pre-admission documentation prior to accepting residents into the facility. Administrator agreed to sign this statement along with the Owner of the facility and to submit this statement to CCLD no later than POC due date.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Trevor Byrne conducted a pre-licensing visit to the above noted facility. The LPA met with applicant, Lousine Sarkisian. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver has been requested. The facility is a one-story home. At 10:23 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for five (5) non-ambulatory residents and one (1) bedridden resident. The facility has two (2) private resident bedrooms, rooms #1 & 3 and two (2) shared rooms, rooms #2 & 4. Bedroom #3 is the approved bedridden room and contains a direct exit to the outdoors of the facility. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are no staff bedrooms at the facility awake night staff are required. All rooms were free of odors. All window screens were clean and maintained in good repair. There are two (2) shared bathrooms in the hallway and one (1) private bathroom attached to bedroom #3. The resident bathrooms have a shower with non-skid materials. Grab bars were observed near all resident toilets and near all resident showers. All were properly secured. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. Continued on LIC 809C. Resident and staff records are stored in a filing cabinet which is currently located in the Administrator’s office. Medications are centrally stored in a locked hallway closet. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in a locked hallway closet. Kitchen knives are stored in a locked drawer in the kitchen. Stove burners are rendered inaccessible to the residents by removing them when not in use. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable food is adequate. There are no pesticides, poisons, or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen and house cleaning supplies are stored in a locked under sink cabinet located in the kitchen. Additional laundry chemicals and cleaning supplies are stored in a locked shed located on the outdoors of the facility. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment, games and/or activity supplies in the living room and dining area. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight were made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. There is a fireplace in the living room. It is sealed off and there are no tools. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility smoke alarm system is hard wired. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. There is one (1) fire extinguisher throughout the house. It was fully charged and did not exceed the expiration date. Continued on LIC 809C. Hot water was tested in each bathroom, which included the resident bathrooms in addition to the kitchen; and, the hot water ranged from 108.3 to 117.3 degrees Fahrenheit. The laundry area is located in an outdoor shed of the facility. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in a locked storage closet along with Extra incontinence. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted in all resident rooms. The emergency telephone numbers along with other required postings are posted in the dining area. The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the front of the house with tables and chairs where residents can sit. The entire property is fenced. There is a door w/gate for persons to enter the front yard. There is a locked storage shed in the back yard. There is an ADU on the property, that is separated and not associated with the facility. There is a small fountain in the front yard of the facility. COMP III orientation was completed with the applicant during this pre-licensing inspection. During today’s inspection LPA obtained a copy of the facility’s current liability insurance. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.the state’s words, verbatim · CDSS document, Jun 30, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Msrian, Janet and Sarkisian, Lousine - Licensee and Administrator Interview Method: Telephone interview On 06/12/2025, 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 that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. 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. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jun 12, 2025

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Emily Peraldi and Angela Barutyan conducted an unannounced case management visit at the above location. The purpose of this visit was to conduct a follow up inspection of the property to check on the health and safety of Tenant #1 (T1) requiring care and supervision. Upon arrival, the LPAs met with staff. At 10:31 a.m., the LPAs spoke with the Operator over the telephone. At 11:01 a.m., the Operator arrived at the location. On 07/02/2024, the Department investigated a complaint alleging "Unlicensed care being provided". The allegation was substantiated as it was determined that the Operator retained T1 and Tenant #2 (T2) were being provided with elements of care which include assistance with activities of daily living such as medication assistance/management, dressing and bathing. T2 is no longer residing at this location. On 02/05/2025, the LPAs conducted a tour of the physical plant and confirmed that T1 resides at this location, and no new tenants were observed at the time of the visit. The Operator stated that on 08/01/2024, an application was sent for licensure. The LPAs confirmed that the application is currently active. The LPAs reminded the Operator not to accept new tenants until they are licensed. No immediate health and safety concerns were observed. Exit interview conducted. No citations were issued at this time. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 5, 2025