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On 04/09/2026, Licensing Program Analyst (LPA) Yi Sam Jian conducted an unannounced case management visit to follow up on an incident report that was submitted to CCLD on 04/02/2026. LPA met with Administrator, Adiam Welday. LPA explained the purpose of the visit. The facility submitted a written incident report stating that on 04/01/2026, at approximately 4:06 PM, R1’s WanderGuard device activated at an emergency exit. Staff were immediately alerted, initiated a search, and located R1 near the front entrance at approximately 4:10 PM. LPA conducted interviews, collected and reviewed documentation. Administrator reported that R1 is placed with 24 hours private companion until further notice. This report is reviewed and discussed with the administrator. A copy is provided.

On April 1, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit. LPA met with administrator, Adiam Welday and LPA explained the purpose of today's visit. During today's visit, the administrator confirmed that staff #1 (S1) is no longer working at the facility and has been disassociated from the facility. This report is reviewed and discussed with the administrator. A copy is provided.

On 2/19/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management visit in regards to an incident self reported by the facility involving a resident who became agitated during meal time, and threatened staff. LPA Calandra was greeted by Adiam Welday, Executive Director/Administrator and explained the purpose of the visit. According to the Administrator, R1 entered the kitchen of the memory care unit and threatened staff. Staff attempted to redirect the resident but R1 became more aggressive and the police department had to be contacted. R1 has been to the doctor recently and re-evaluated. No other incidents have been reported at this time. During the visit, LPA received copies of R1's recent assessment and discharge notes. During record review, LPA observed that the incident had not been reported to the Department for 10 days. Licensees are required per Title 22 to submit a written report within 7 days of the occurrence. A Technical Assistance Advisory note was provided explaining the best practice to maintain compliance. No deficiencies were cited during today's visit. An exit interview was conducted. A copy of the report and Technical Assistance were provided.

On 12/23/2025, Licensing Program Analyst (LPA) Yi Sam Jian conducted an unannounced case management visit regarding an incident report. LPA met with Executive Director, Adiam Welday, LPA explained the purpose of the visit. On 12/17/25 , the facility reported that a resident’s family member alleged missing personal property from the resident’s room at the facility. No photographs or documented values of the items were available at the time of the report. At the time of the visit, the resident was hospitalized and undergoing treatment . The LPA interviewed staff and collected relevant documentation . The LPA reviewed the report with the Executive Director , and a copy of the report was provided to the Executive Director .

On 12/3/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management visit in regards to an incident that occurred on 11/25/2025 in which a resident, R1 was able to leave the facility unassisted. LPA Calandra was greeted by Sayma Arnautovich, Director of Housekeeping an and explained the purpose of the visit. Daisy Dizon, Director of Memory Care arrived later during the visit. According to Sayma Arnautovich, Director of Housekeeping, R1 lives in a memory care apartment and frequently takes walks outside of the community in a gated outdoor space. On 11/22/2025, R1 walked out of their apartment and walked towards a gated outside space. From there R1 was able to leave the facility unassisted and was found four hours later by staff with no apparent injuries when they returned to the facility front steps. Based on observations, and interview, all door alarms and delayed egress systems were working properly. LPA requested a copy of R1's LIC 602 Physician's report. According to the medical assessment which was dated last year, R1 is not at risk if allowed to leave the community unsupervised due to dementia or cognitive decline and is not a wander risk. LPA received a copy of the physician's report and last doctor's visit record during the visit. No deficiencies cited during today's visit. An exit interview was conducted. A copy of this report along was provided.

On 8/22/2025, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced Annual inspection visit. LPA met with Regional Operations Specialist, Chris Schuster and explained the purpose of the visit. LPA conducted a tour of the facility with Director of Housekeeping, Sayma Arnautovich, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Residents are either engaged in activities or are in the tea rooms or dining area. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located on each resident floor and kitchen. Carbon monoxide detectors were located at each hallway. Smoke detectors and fire safety systems are interconnected. Water at faucets accessible to residents measured at 110 degF. There was a sufficient supply of both perishable and nonperishable foods. Facility provides a wide variety of meal preferences and preparation while also ensuring proper dietary restrictions are followed. Cleaning supplies and other toxins are safely stored in locked closets throughout each floor, and housekeeping/maintenance rooms all of which were secured upon inspection. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. Seven resident records and seven staff records were reviewed. All records are complete and updated. Staff has annual training logs. Medication room was reviewed and everything is complete and locked in the med room. No deficiencies cited today. Report is reviewed and copy is provided.

Based upon review of R1’s physician’s report, R1 is cognitively able to determine their own medical and assistance needs. Interviews with residents (R1, R2), responsible party (I1) and witness (I2) indicated the facility is providing appropriate care and meeting resident needs with no concerns indicated. A finding that the complaint allegation client's care needs not met by staff is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiency cited.

Staff did not maintain current resident records. LPA conducted a review of R1’s records and found that the facility had maintained R1’s medication records. Upon additional interview with Reporting Party, LPA received contradicting information to the initial complaint intake statement. LPA was not provided specific information on medication record issues by Reporting Party. Upon review of R1's medication records, LPA found that R1's medication administering records were on file. Staff are not communicating with responsible party regarding resident's care service. Upon interview with Executive Director, and corresponding documented communication with R1’s, responsible party, it was determined that there was documented communication from the facility regarding R1's care service. From documentation gathered, LPA found contradicting information in relation to the allegation. A finding that the complaint allegations, staff did not distribute resident's medication as prescribed, staff did not maintain current resident records and staff are not communicating with responsible party regarding resident's care service are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Complaint also alleges a second medication for daily administration was not provided. Upon interviews with staff and a review of R1's medication records, LPA gathered information regarding medication delivery and orders. Facility staff (S2,S3,S4) statements were consistent, indicating that the medication was delivered but a physician order was not included. Staff stated they contacted R1's hospice agency multiple times by phone, requesting for the signed order. Lastly, the signed physician's order was eventually provided several days after the delivery for reconciliation, indicating potential delay in documentation being provided to the facility. R1 was provided the medication the following day of receiving the signed order. LPA determined that there is conflicting information and a lack of corroborating evidence towards the allegation. Complaint alleges, staff did not refill resident’s medication prescription in a timely manner. Upon review of resident records it was found that R1 was prescribed a daily medication that assist with bowel movement. In addition, R1 is also prescribed a second medication that targets bowel movement, but only used as needed (PRN) when the primary daily medication is not effective after several days. Interview with Executive Director (S1) and review of R1's medication and hospice records indicated that the amount of PRN medication administered was within the total quantity of the PRN medication doses on supply. There is no other indication of R1's observed symptoms in either charting notes, hospice records or medication records that indicate R1's need for additional PRN nor indication of the facility not having sufficient supply on hand. LPA attempted to contact the hospice agency but was not able to gather statement. A finding that the complaint allegations, staff did not ensure that resident was dispensed their medication as prescribed and staff did not refill resident’s medication prescription in a timely manner are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Reporting Party claims that all expenses are owed to residents (R1 & R2) because neither resident had not physically moved into the facility. Based upon interviews with staff (S1) and outside parties (I1,I2), LPA found that R1 & R2 had a signed effective agreement and were able to move into the facility as of 7/31/2024. However, it was found that R1 & R2 voluntarily refused to move their belongings into the facility from their personal home with said effective agreement and paid community and rent fees. Lastly, document review also indicated that R1 & R2 had submitted a withdrawal letter dated 8/30/2024 to the facility however was unsigned. A second letter was submitted to the facility dated 9/2/2024 declared an outside party (I1) as residents' (R1 & R2) authorized representative. A final letter from I1 dated 9/6/2024, requested a full refund of fees. Although LPA found that the facility received inconsistent documentation for withdrawal, a request was initially submitted by residents' (R1 & R2) within the first month of rent. Again it is indicated on the signed admissions agreement, that R1 & R2 had agreed to facility admission, effective 7/31/2024 and are not owed the alleged amount. In consideration to time frame of withdrawals, the facility was found to have provided the appropriate pro-rated community fees refund amount to residents (R1 & R2). The agency has investigated the allegation and we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies cited during today's visit.

On 8/21/2024, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Executive Director, Katherine Raukhman. The facility currently provides care for 127 residents, 6 of which are receiving hospice services, along with a designated memory care unit. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located on each resident floor and kitchen were found to be last charged on 11/8/2023. Carbon monoxide detectors were located at each hallway tested and functioning. Smoke detectors and fire safety systems are interconnected. Fire Safety Inspection was completed on 8/16/2024 indicating all fire safety devices and systems to be in order. Water at faucets accessible to residents measured between 105.3 and 114.4 degrees F which is within regulation. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen, sufficient for residents in care. Food supply is replenished twice per week and stored properly. Facility provides a wide variety of meal preferences and preparation while also ensuring proper dietary restrictions are followed. Cleaning supplies and other toxins are safely stored in locked closets throughout each floor, and housekeeping/maintenance rooms all of which were secured upon inspection. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. Residents that were awake during the inspection were observed interacting with staff, fellow residents and visitors in the common areas, or in their bedrooms resting. The facility encourages regular family visits and utilizes a wide variety of activities with LPA observing staff engaging continuously with residents, offering activities based on individualized preferences and abilities. LPA found that staff and resident engagement is well practiced with activity calendars developed on a monthly basis. Residents were observed to have a positive and personable relationship with staff and Executive Director. There are multiple outdoor patios for resident use, all equipped with appropriate shading Continued onto LIC809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA conducted a sample file review for 10 residents and found all items to be in order. Upon a spot check of five (5) staff files, LPA found that caregiver staff have current 1st aid and CPR and annual training completed. Lastly, A spot check of medications in both assisted living and memory care was conducted and found that all medication counts and records are in order. Katherine Raukhman's Administrator Certificat e 7007732740 is currently active through 12/26/2024. LPA requested the following documents be sent to CCL by COB 9/4/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan Liability Insurance No deficiencies cited during today's visit.

On May 23, 2024, at 8:45 AM, Licensing Program Analyst (LPA) John Calandra conducted an unannounced visit. LPA Calandra met with Executive Director, Katherine Raukhman and explained the purpose of today’s visit. LPA Calandra delivered an immediate exclusion letter to exclude a private companion who worked in the facility before. The private companion is not on shift today and the Executive Director was advised that they are not allowed to work in the facility. The letter was given to and reviewed by the Executive Director, Katherine Raukhman. This report is reviewed and discussed, and a copy is provided.

On August 2, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced Pre-Licensing visit. LPA met with Executive Director, Katherine Raukhman and explained the purpose of the visit. LPA toured facility and grounds. Indoor and the outdoor passageways are free of obstruction. No accessible bodies of water or fire safety hazards observed. This is a 4 story facility; Assisted Living on all floors and secure locked Memory Care neighborhood on the first floor. Bedrooms observed during the tour were equipped with sufficient lighting, required furniture, non-skid mats, grab-bars and pull alarm systems. Communal bathrooms observed were clean and free from odor. Water temperatures throughout the facility was measured at 112-113F on each floor. Laundry rooms utilized by residents were located on the 2nd-4th floor. Main laundry room for staff is located on the first floor. Chemicals and toxins were observed to be locked and inaccessible to residents. The first-aid kit is inspected and complete. Living room and dining room was observed to be comfortable and free from tripping hazards. Comfortable temperature is maintained throughout the facility and lighting is sufficient for comfort. Hallway lights remain on at all hours of the day. Extra linen was observed on the 4th floor. LPA toured the the kitchen and observed it to be clean and sanitary. Facility refrigerator temperatures are within regulatory standards. Dry goods/emergency food supplies are stored on the first floor. LPA observed 2 medication rooms on the first floor; one on the Assisted Living side and one in the Memory Care neighborhood. A random sampling of resident and staff records is conducted. All required records are maintained. Required posting are posted on the main floor. Facility is overall clean and in good repair based on observations made today. Facility is in compliance with Title 22 regulations. Comp III orientation was given to the Administrator. Immediate Licensure is recommended pending final approval from the Central Applications Bureau. Report is reviewed with Executive Director and a copy is provided.

Facility Type: RCFE Application Type: CHOW Capacity:168 Census (if any clients in care): COMP II Participants: KATHERINE RAUKHMAN , ADMINISTRATOR Interview Method: Telephone interview On 5/5/23, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions