Facility Evaluation Report

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.