Routine inspection·November 18, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 1:17PM. The LPA met with the Administrator Vahagn Harutyunyan who arrived at 1:46PM, and explained the reason for the visit. Entrance interview conducted. Beginning at 1:50PM, the LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The living room had a screened fireplace that was inoperable. Required postings were observed in the living room. The facility maintained a comfortable temperature throughout the visit. KITCHEN: The LPA observed knives stored inaccessible in a locked cabinet and cleaning supplies secured under the sink. Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food, as well as emergency food. Food in the refrigerator and freezer were observed to be of good quality and properly stored. An additional locked cabinet contained resident medications and files. GARAGE: Attached to the kitchen was the garage. The garage remained inaccessible to residents and contained general storage, laundry machines, emergency water, and additional food. The food in the extra refrigerator and freezer were of good quality. Continued on LIC 809-C Laundry machines were observed to be operational. The LPA observed a curtained off area of the garage which was utilized for live-in staff and their relative. The Administrator stated it was temporary and that it was not a “staff room,” however confirmed that staff resided in the curtained area. The LPA explained that the facility was not cleared for a staff room and that they were in violation of the facility’s fire clearance. The Administrator shrugged their shoulder and reiterated it was not a staff room. BEDROOMS/RESTROOMS: There were three (3) total bedrooms. Bedroom #3 had a direct exit to the outside and approved for one (1) bedridden resident. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens were stored in Bedroom #3’s closet. The LPA also observed blinds in Bedroom #3’s sliding door were missing/broken. The Administrator stated the resident broke the blinds 1-2 days prior. There were two (2) total restrooms in the facility: one (1) private restroom and one (1) shared resident restroom located in the hallway. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. The hallway bathroom did not have a grab bar inside the shower. The Administrator stated they were approved this way and never had any issues and shrugged their shoulders. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested in the resident restrooms and measured between 111.2 degrees F and 112.3 degrees F. The Administrator stated all residents utilized the private restroom located in Bedroom #3 as an extra restroom if the hallway restroom was occupied. Additionally, the Administrator also stated the staff utilized the private restroom. The LPA explained to the Administrator that the private restroom can only be used by the residents who resided in Bedroom #3, and they shrugged their shoulders. The LPA observed accessible cleaning products under the sink in the private restroom. The Administrator added a lock during the visit. OUTDOOR AREA: The rear yard had a shaded area with furniture in good condition for resident use. The facility had one (1) emergency side exit gate. There was an attached Additional Dwelling Unit (ADU) in the rear yard occupied by unrelated parties. Report Continued on LIC 809-C RECORDS: Record review began at 2:17PM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. Resident #1 (R1), Resident #2 (R2), and Resident #3 (R3) did not have updated Appraisals/Needs and Service Plans and Physician’s Reports. Documents were last updated between 6/20/2024 and 9/12/2024. R2’s Consent Forms and Personal Rights were not signed. Resident #4 (R4) was admitted 4/26/2025 and did not have a signed Admission Agreement, Appraisal/Needs and Service Plan, Consent Forms, or Personal Rights. The Administrator shrugged their shoulders and stated their families need to sign the paperwork, and he could not sign it for them. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. The emergency disaster plan was last reviewed in 2019. The Administrator stated nothing has changed and the LPA explained it needs to be reviewed and signed annually. Emergency disaster drills are conducted quarterly, with the last documented drill on 10/11/2025. Smoke and carbon monoxide detectors were tested at 2:58PM and were operational. Fire extinguishers were observed and purchased on 11/04/2025. Due to time constraints, the LPA will return at a later date to continue the annual visit. Pursuant to Title 22 CA Code of Regulations and/or Health and Safety Code, the following deficiencies were cited (Refer to LIC 809-D). An immediate civil penalty of $500 for a violation of the facility’s fire clearance was issued (Refer to LIC 412M). The Licensee understands that continued violation of the facility’s fire clearance may result in additional civil penalties. Exit interview conducted. A copy of the appeal rights and report was reviewed and provided.