Facility Evaluation Report

Licensing Program Analysts (LPA Brian Balisi conducted a Case Management - Deficiencies visit report during the investigation of Complaint Control #29-AS-20231108131542. Reason for this report is to issue deficiency observed during the complaint investigation which were unrelated to the complaint allegation. During today’s visit, LPA met with Staff and explained the reason for the visit. Licensee Sarkis Dovlatyan arrived shortly after.

During records review, LPA did not observe a Centrally stored medication log in Resident #1’s (R1) and a LIC 624 was not submitted to the Department for R1’s hospitalization on 11/01/2023

A Repeat Violation Civil Penalty is assessed in the amount $250.00 for deficiency that was previously cited on 07/30/2024 on Complaint Control # 29-AS-20230714110246. Licensee was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f). Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC 9099-D).

During the visit Sarkis Dovlatyan had to leave the facility due to personal reasons, but stated staff can sign in their place.

Exit interview conducted. A copy of the report and appeal rights provided.