102416.2(a)(2) · Reporting Requirements. The licensee shall report the following information to the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). Any change in household composition including adults moving in or out of the home and The Licensee will review Title 22 Regulations Section 102416.2 on Reporting Requirements and develop a written Plan of Correction (POC) to ensure compliance. Written POC must be submitted to CCL by the POC due date. anyone living in the home who reaches his or her 18th birthday.

During a visit conducted at the facility, the LPA discovered that the Licensee’s brother Narek Sedrakyan, and the brother’s spouse Veronika Boshyan have moved in and are now residing at the facility. This poses an immediate health, safety or personal rights risk to persons in care. Katrina Chicote NAME OF LICENSING PROGRAM MANAGER: Joe Katrdzhyan NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/06/2026 I acknowledge receipt of this form and understand my appeal rights as explained and received.

Not marked corrected in the state record