Staffing, personnel, and trainingType A
- Official classification
- Type A
- Official code
- 87411(f)
- Regulation authority
- CCR
What the official deficiency says
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above as Armenak Saakyan, Licensee/Caregiver did not maintain evidence of a health screening in their file which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/02/2026 Plan of Correction The Licensee will review and ensure that all staff files to contain a health screening with the results of a TB test maintained in their files. Provide evidence that Armenak Saakyan has obtained a health screen and placed in his file by 6/2/26.
Background checksType A
- Official classification
- Type A
- Official code
- 87355(e)(3)
- Regulation authority
- CCR
What the official deficiency says
(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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above as it was noted that 3 out of 5 facility staff - Mary Mkrtchyan, Nvard Manukyan and Arev Misakyan have not requested a criminal record clearance transfer prior to being present at the facility, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 05/27/2026 Plan of Correction The Licensee will ensure that all staff, volunteers and any persons who are required to have a criminal record clearance are also associated to the facility prior to being present at the facility. The Licensee will go on Guardian and associate Mary Mkrtchyan, Nvard Manukyan and Arev Misakyan or submit a completed LIC9182 with a copy of a legible driver license to the Department to associate the 3 staff by 5/27/26.
Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87506(a)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above as the resident records have incomplete Identification and Emergency Information, missing Consent for Emergency Medical Treatment, no updated Admission Agreements for Resident #2, no doctors orders for use of bed rails which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/02/2026 Plan of Correction The Licensee, will review all resident records to ensure that all the required documents are in all residents files. Provide evidence that the files have been reviewed and the required documents have been obtained and are in the residents' files by 6/2/26.
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87463(b)(1)(F)
- Regulation authority
- CCR
What the official deficiency says
(b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. (1) Significant changes in condition, as defined in Section 87101, Definitions, include, but are not limited, to: (F) Whether the resident’s and other residents’ safety would be at risk if the resident is allowed to have access to any of the items specified in Section 87307, Personal Accommodations and Services and in Section 87309, Storage Space and Access. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above as reappraisals observed in residents's files were completed but no meetings have been scheduled with the family's or the residentts to discuss the reappraisals or any changes in condition which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/02/2026 Plan of Correction Licensee will ensure that an annual reappraisal is conducted every 12 months or as needed to document any changes in condition. Licensee shall schedule meetings with families and resident to complete the reappraisals by 6/2/26
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87507(c)
- Regulation authority
- CCR
What the official deficiency says
(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident's representative, if any, and the licensee or the licensee's designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above as it was observed that Resident #2 and Resident #5 do not have a completed Admission Agreement on file which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/02/2026 Plan of Correction Licensee will ensure that an Admission Agreement is completed and signed no later than 7 days following admission. Resident #2 (Admitted on5/1/25) and Resident #5 (admitted on 12/1/25) do not have completed Admission Agreements on file. Licensee will obtain completed Admission Agreements and maintain in the residents files by 6/2/26
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87411(c)(1)
- Regulation authority
- CCR
What the official deficiency says
1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above as Nvard Manukyan, Caregiver, has an expired first aid card and does not have evidence of current training, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/02/2026 Plan of Correction The Licensee will ensure that all staff have current first aid training from persons qualified by such agencies as the American Red Cross prior to working alone with residents at the facility. Provide evidence that Nvard Manukyan has obtained current training by 6/2/26