Facility Evaluation Report

Licensing Program Analysts (LPA) Brian Balisi conducted an unannounced Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint control # 29-AS-20240416124733). The purpose of this visit is to issue citations for deficiencies observed during the complaint investigation which were not related to the complaint. Upon arrival LPA met with Staff Zhyparkul Mursamambetova and explained the reason for the visit. LPA contacted Licensee Sarkis Dovlatyan who stated they are unable to make the visit, but stated staff can sign in their place.

The facility did not submit a Special Incident Report (SIR) or death report to Community Care Licensing (CCL) to notify that Resident #1 (R1) was admitted to the hospital on 04/13/2024, and R1’s death in the hospital on 05/09/2024.

Facility admitted and retained R1 with unstageable pressure injuries to both heels and a Stage 2 pressure injury to sacro coccyx without submitting and exception request for the prohibited condition (unstageable pressure injuries) and obtaining approval from CCL.

Staff #1 (S1) stated they are the only staff at the facility and has worked as a caregiver at the facility since 03/15/2023. S1 stated they work “six days a week, 24 hours a day.” S1’s duties as a caregiver include cooking, cleaning, laundry, showering, changing diapers, and changing clothes. Resident #2 (R2) stated S1 works “24/7”.

Records review lists Lala Soghomonyan as Administrator, but there were no records to review on site. LPA contacted Lala who stated they were unable to make it to the facility.

Citations issued, exit interview, appeal rights given.