Wyandotte Villa

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Antonia Alvizar-Ettima for a case management visit to follow up with the incident report provided to the Licensing office on 06/26/26, informing that resident #1 (R1) became unresponsive during bathroom assistance. 911 was called and R1 was sent to the hospital. During conversation, LPA was informed that R1 was admitted to the facility with a G-tube, R1 was unable to self-assist with a G-tube and was not a hospice resident. LPA made a follow-up contact and spoke with the staff and Administrator. Information received revealed that R1 was admitted, retained and readmitted to the facility with prohibited health conditions that required higher level of care. Therefore, LPA conducted follow up visit to get additional information regarding resident health conditions and other surrounding circumstances of the incident. During the visit, at 3:00p.m., LPA toured the facility and at about 3:20p.m., LPA spoke with staff and R1. In addition, at approximately 3:45p.m., LPA reviewed R1’s file. A review resident R#1 (R1) records conducted at revealed the information regarding R1’s home health care services and medical conditions. LPA observed that R1 has a gastrostomy (G) tube. R1 stated that Staff #1 (S1) oversee their daily G-tube care, while the home health nurse visits once weekly. Record reviewed and staff interview indicated the resident is unable to independently perform all aspects of G-tube feeding and care. During this visit LPA Alvizar-Ettima also discussed Title 22 regulations pertaining to restricted and prohibited Cont. on LIC 809 - C Cont. from LIC 809 health conditions, exceptions and waivers and other pertinent information. Based on observation, interviews and record review and interviews, the facility admitted, and retained a resident with a prohibited health condition, requiring higher level of care. This posse an immediate concern to Resident’s health and safety. Therefore, under title 22, Division 6, Chapter 8, following deficiencies were cited and recorded on LIC809D. An immediate Civil penalty of $500.00 was issued at the time of this visit. Exit interview was conducted, appeal rights were discussed and information on the report was disclosed to the Administrator. Due to printing problems, the copy of the report will be e-mailed to the Administrator.the state’s words, verbatim · CDSS document, Jul 8, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(2) · Plan of correction due date: Jul 9, 2026

87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (2) Gastrostomy tubes. This requirement is not met as evidenced by. Operator continued to retain R1 requiring higher level of care. This possess an immediate health and safety risk for resident in care.the state’s words, verbatim · CDSS document, Jul 8, 2026

Plan of correction: Administrator will seek higher level of care placement by POC due date. Administrator will submit written documentation indicating where resident was placed.

Allegation investigated: Licensee allows uncleared staff to provide care to residents

At 10:15a.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an initial complaint visit to investigate the above-noted allegation. LPA contacted the Administrator via telephone and explained the purpose of the visit. Later, Assistant Administrator arrived at the facility. LPA Alvizar-Ettima and Assistant Administrator conducted a physical plant tour. During the visit, LPA Alvizar-Ettima did not observe any residents or staff present at the facility. LPA also did not observe personal belongings or other indicators that residents were currently residing in the home. The Administrator and Assistant Administrator reported that the facility has not had residents in care and has not hired staff, as the facility has not been in operation since it was licensed. LPA observations during the visit were consistent with the information provided by the Administrator and Assistant Administrator. Based on observations and information obtained, there is insufficient evidence to support the allegation. Therefore, the finding for the complaint allegation is UNFOUNDED. It was determined that the complaint was without a reasonable basis and dismissed the complaint. No health & safety hazard noted during this visit. Exit interview was conducted. Copy of report was issued. Unfoundedthe state’s words, verbatim · CDSS document, Apr 29, 2026 · control 31-AS-20260423092323

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Tan conducted an Annual Required inspection of this facility today. LPA met with the House manager, Serge Petrosian and explained the reason for the visit. Per the house manager, they never had any client since opening and currently applying for vendorization at the North Los Angeles Regional Center (NLARC) Level III RCFE. A tour of the physical plant was conducted at 9:39 AM and the following was noted: 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 Infection Control and Mitigation plan. The facility is fire cleared for six (6) non-ambulatory residents one (1) for may be bedridden in room #1. Facility was also approved for a Hospice waiver for six (6) residents. The facility is a single storey building and has four (4) bedrooms and two (2) bathrooms currently with no residents. The facility dual smoke/carbon monoxide alarm system are hard wired and interconnected, tested and observed to be operational. The fire extinguisher is located by the dining area and was observed to be fully charged and last purchased on 09/14/25. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility and properly stored. Knives were stored in a locked drawer . Bedrooms: All four resident rooms were properly furnished with appropriate beddings and linens with sufficient lighting. (continued on LIC 809-C) (continued from LIC 809) Bathrooms: The bathrooms for the residents were observed to have grab bars, non-skid mats and properly supplied with hygiene products. Hot water temperature was measured at a range of 115.2°F to 117.5°F. LPA did not observe any toxins or cleaning supplies in any of the bathrooms during the day's visit. Common Areas: These included the living room and dining area. The common areas were properly furnished. The dining room area and table is large enough to accommodate up to six (6) residents. The auditory alarms on all exit doors were on and functional at the time of the visit. The fireplace is non-operational and there was a glass and screen door in place. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area is located in bedroom hallway and was locked at the time of the visit. Detergents and cleaning supplies are kept in a bedroom hallway cabinet, locked and inaccessible. Garage: There is no garage at the facility only drive way. This driveway leads to two (2) additional dwelling unit (ADU) with a separate address, the ADUs gate was locked and has no access from the facility. Laundry Area: LPA observed the laundry area is located by the living room. Laundry detergents, cleaning agents and other toxins were kept in the locked cabinet in the bedroom hallway. Medications: Medications will be kept in a locked cabinet in the bedroom hallway. There are two (2) complete first aid kits located in the medication closet. 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, Sep 14, 2025

Type of visit: Prelicensing

At 10:30am Licensing Program Analysts (LPA) Leizl de la Cerra conducted an announced Pre-Licensing Inspection to the above facility and met with Rafael Petrosian, Administrator and co-administrator, Margarit Sarkisyan. The LPA will inspect the facility to ensure that the facility is in compliance with the rules and regulations under California Code of Regulations, Title 22, Division 6. Fire Clearance was approved on 06/04/2024 for a maximum capacity of six (6) residents, of which five (5) are for non-ambulatory and one (1) for a bedridden resident in room #1. Facility was also approved for a Hospice waiver for six (6) residents on June 05, 2024. The facility is a single-story building. At 10:45am, with the assistance of the Licensee, LPA conducted a facility tour of both the inside and outside premises and observed the following: KITCHEN: The kitchen is equipped with a refrigerator, microwave oven and sink. LPA observed adequate supplies of nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. BEDROOMS: There are four (4) bedrooms designated for client use. Bedroom #1 is cleared for one (1) bedridden. . All bedrooms are furnished with beds, night stands, chair, flashlights and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Extra bed linens and towels are stored in a closet in the bedroom hallway. BATHROOMS: LPA observed two (2) bathrooms that are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured between 110°- 112°F. observed the appropriate grab bars and have non-skid mats. Continued to LIC809-C COMMON AREAS: The facility maintains a comfortable temperature at 73°F. The living room and dining appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the common area. SURROUNDING GROUNDS: LPA observed the front area of the facility as a sufficient yard space fro residents to use. Appropriate outdoor furniture, with a covered shaded area is available for residents. LPA observe the garage is separate from the house and is located at the back area. The garage is locked and will be inaccessible to residents in care. LAUNDRY AREA: LPA observed laundry area located by the common area. The washer/dryer appear to be in good condition. Cleaning solutions, laundry detergents and other hazardous cleaning materials are kept inaccessible in a locked cabinet located in the bedroom hallway. The medications will be kept in locked cabinet in the bedroom hallway. inaccessible to residents in care. The first-aid kit is complete. There is two drawer locked cabinet and a 4 drawer locked cabinet which will contain resident files and staff records located in the common area. The facility smoke alarm system is hard wired and interconnected. The fire extinguisher is located near the dining area and was observed to be fully charged and was last purchased on 07/31/24. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. Alarms were tested and observed to be operational. Component III Orientation was conducted with the administrator/applicant during the visit. LPA de la Cerra will notify the Centralized Applications Bureau (CAB) Analyst of the completed Pre-Licensing inspection. The CAB Analyst will notify applicant when license is approved. Exit interview was conducted and a copy of the signed report has been emailed to the applicant.the state’s words, verbatim · CDSS document, Aug 1, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Sarkisyan, Margarit; Petrosian, Rafael - Applicant/Administrator Interview Method: Virtual interview On 06/10/2024, 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 10, 2024