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Inspection visit

Incident investigation

ASSISTED SENIOR CARE FACILITYLicense 1976103065 citations on this visit
5 citations recorded

Inspector’s narrative

What the inspector wrote

At 10:00 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced Case Management - Incident visit to this facility and met with staff and the Administrator Gayane Aghabekyan and Administrator Rima Agaronyan were contacted and arrived at the facility shortly after. LPA explained the reason for the visit. On 04/30/2025, Community Care Licensing Division (CCLD) received an incident report for Resident #1 (R1). It was reported that on 04/28/2025 , R1 was noted to have a skin breakdown and the Administrator contacted R1's Primary Physician and R1 was assessed by Kaiser Home Health Registered Nurse(HHRN). The (HHRN) confirmed that R1 has stage 3 pressure ulcer near the buttocks area. During today's visit, LPA conducted an interview with R1 who informed LPA that two weeks prior to 04/28/2025, the staff #1, Hasmik Yeghiazaryan noticed redness on the buttocks area. R1 also informed LPA that the staff was repositioning R1 each four (4) to five (5) hours daily prior to 04/28/2025. Furthermore, LPA conducted an interview with the Administrator and Administrator Designee and both denied ever been notified from any of the staff that R1 had any redness prior to 04/28/2025. LPA conducted review of R1's facility file, Physician Report dated 04/1/2024, Preplacement Appraisal date on 03/09/2024, Appraisal Needs and Services Plan on 04/30/2025. Admission Agreement date on 03/9/2024. Review of Physician report revealed that R1 has history of skin condition or breakdown near buttock area and review of Appraisal Needs and Services Plan revealed that page #4 was completed partially, and page #5 was completed only; therefore, no proper assessment was conducted and R1 ended up having stage 3 pressure ulcer as of 04/28/2025. Although R1 currently is receiving wound care through Kaiser home health, the facility failed to submit an exception letter to CCLD in a timely manner. Therefore, deficiencies will be cited on LIC 809D. Appeal rights explained copy of this report signed and delivered.

Citations

5 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87412(c)(2)(AType B

    Personnel Records:(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include:This requirement is not met as evidenced by: Based on interviews and record review the licensee did not comply by not making sure all trained staff followed the "in service" training knowledge and conducted daily body checks on R1 for the history of skin breakdown which poses a potential health and safety risk to residents in care.

  • 87463(a)Type B

    Reappraisals: (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary....... the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical...This requirement is not met as evidenced by: Based on interview and record reviews, licensee did not comply with the section cited above. Administrator completed partial reappraisals for R1 on 04/30/2025 upon observing the stage 3 ulcer on R1's buttocks area, which poses/posed a potential health and safety risk to resident in care.

  • 87464(f)(1)Type B

    Basic Service: (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 reviews the licensee failed to provide care and supervision to R1 who developed stage 3 ulcers residing at the facility which poses a potential health and safety risk to residents in care.

  • 87611(a)Type A

    87611(a) General Requirements for Allowable Health Conditions (a) Prior to accepting or retaining a resident with an allowable health condition as specified in Section 87618… Section 87631, Healing Wounds; licensees… shall obtain Department approval:This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above by not obtaining an approval from the department for R1's prohibited health condiction (stage 3 pressure wound) which was discovered on 04/28/25 this poses an immediate health, safety or personal rights risk to persons in care.

  • 87615(a)Type A

    87615(a) 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: (1) Stage 3 and 4 pressure injuries. Based on record review & interviews the licensee did not comply with the section cited by R1 developing stage 3 ulcers while under the facility care. This poses an immediate health and safety risk to the resident in care.

FAQ · About this visit

Common questions about this visit

What happened during the May 2, 2025 inspection of ASSISTED SENIOR CARE FACILITY?

This was a other inspection of ASSISTED SENIOR CARE FACILITY on May 2, 2025. 5 citations were issued: 2 Type A (serious) and 3 Type B.

Were any citations issued to ASSISTED SENIOR CARE FACILITY on May 2, 2025?

Yes, 5 citations were issued (2 Type A, 3 Type B). The first citation was for: "Personnel Records:(c) Licensees shall maintain in the personnel records verification of required staff training and orie..."

What type of inspection was this?

This was a other inspection. other inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.