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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603259
Report Date: 02/06/2025
Date Signed: 02/06/2025 07:25:59 PM

Document Has Been Signed on 02/06/2025 07:25 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:SWEETZER SENIOR GARDENFACILITY NUMBER:
198603259
ADMINISTRATOR/
DIRECTOR:		TEKEIAN, DIANAFACILITY TYPE:
740
ADDRESS:8309 WEST 3RD STREETTELEPHONE:
(323) 639-5934
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY: 6CENSUS: 2DATE:
02/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:03 AM
MET WITH:Zaruhi TekeianTIME VISIT/
INSPECTION COMPLETED:
01:59 PM
NARRATIVE
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On 2/06/25, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced required Annual visit with a primary focus on infection control. LPA was met by Zaruhi (Sara) Tekeian, House Manager and administrator Hasmik Tekeian, were informed the purpose of today’s visit was to conduct annual inspection.

There are currently (2) residents in the facility. The facility is a double-story structure with a ramp and front porch located in a residential / commercial neighborhood. The facility is located in the back of the building near the alley. It consists of four (4) bedrooms (one (1) in loft), (2) full bathrooms, kitchen, living / dining room, shaded front yard, laundry room, loft and no garage.

LPA and house manager Tekeian toured the physical plant. There are no bodies of water or firearm/ammunition on the premises. All resident rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for resident's personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were clean and operational, yet outside of Title 22 regulations. The water temperature measured at 110.3 F.



A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to resident. The kitchen was inspected and there is enough perishable and non-perishable food available which is stored properly. Fire extinguisher was charged, smoke detectors and Carbon Monoxide were operable.

Evaluation Report continues LIC 809-C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: SWEETZER SENIOR GARDEN
FACILITY NUMBER: 198603259
VISIT DATE: 02/06/2025
NARRATIVE
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During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, sanitizing stations (located in common areas and restrooms). All mandated CCL posters were posted.

Audit of (2) resident service files and (5) staff personnel files were determined to be maintained in order. The facility has current liability insurance coverage from 06/18/24 through 06/18/25 policy # 0100245575. A current administrator's certificate for Hasmik Tekeian #7027086740 - valid through 02/02/2026.

DEFICIENCIES:

  • Resident #2 had full bed rails and was not on hospice care nor had physician's orders for bed rails.
  • Staff #2 had incomplete personnel file. Staff #2 had missing First Aid/CPR Training and TB Test Results.
  • Staff #1 did not have criminal clearance background association transfer in LIS or Guardian.

Exit interview held. A copy of the report, deficiencies, civil penalties, and appeal rights were provided to Hasmik Tekeian.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 02/06/2025 07:26 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 02/06/2025 at 01:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SWEETZER SENIOR GARDEN
FACILITY NUMBER: 198603259

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(e)(2)
Criminal Record Clearance (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: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c)

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above. LPA identified staff #1 (S1) did not have criminal record clearance transfer. Staff did not have an LIC 9162 on file nor transferred on CDSS Guardian. This violation which poses an immediate health, safety, or personal rights risk to persons in care.
POC Due Date: 02/07/2025
Plan of Correction
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Licensee will ensure all staff have criminal clearance transfer prior to working at the facility. Staff #1 (S1) according to CDSS Guardian is not associated to this facility. Licensee will associate staff #1 (S1) by POC due date. Send proof of correction by email to ernand.dabuet@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Janae Hammond
LICENSING EVALUATOR NAME:Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2025


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 02/06/2025 07:26 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 02/06/2025 at 01:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SWEETZER SENIOR GARDEN
FACILITY NUMBER: 198603259

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87411(c)(1)
(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
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Based on record review, the licensee did not comply with the section cited above. Staff #2 does not have current First Aid training in staff records. This violationwhich poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2025
Plan of Correction
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Licensee will ensure all the staff will have current first aid training. Administrator will send proof of correction by POC date 02/27/25. POC must be sent to LPA Ernand Dabuet at: ernand.dabuet@dss.ca.gov
Type B
Section Cited
CCR
87411(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Staff 2 health screening form with no TB in staff records. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2025
Plan of Correction
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Licensee will ensure all the staff have health screening form with TB result in staff record. Administrator will provide proof of correction by POC date 02/27/25. POC must be sent to LPA Ernand Dabuet at: ernand.dabuet@dss.ca.gov
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Janae Hammond
LICENSING EVALUATOR NAME:Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 02/06/2025 07:26 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 02/06/2025 at 01:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SWEETZER SENIOR GARDEN
FACILITY NUMBER: 198603259

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87608(3)
87608 Postural Supports (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA identified Resident #2 who is not on hospice with full bedrails without physician’s order. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2025
Plan of Correction
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Licensee shall review Title 22 Regulation 87608. The administrator shall obtain a written prescription for full bedrails. The administrator shall also send a written statement to CCL to the attention of LPA Dabuet that regulations have been reviewed and a physician’s order for full bed rails is obtained. Proof of correction is due by 02/27/25.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Janae Hammond
LICENSING EVALUATOR NAME:Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2025


LIC809 (FAS) - (06/04)
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