Routine inspection·April 9, 2025

On 04/09/2025 at 1:30 PM, Licensing Program Analysts (LPAs) P. Manalo and K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Administrator, Imir Dzhudzho, and explained the purpose of the visit. Administrator certificate expired on 11/3/2025. LPAs toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 3 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. There are no bodies of water observed. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 130.8 degrees Fahrenheit. A comfortable temperature is maintained at 73 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last purchased on 04/09/2025. First aid kit was observed to be complete. At 1:31 PM, LPAs reviewed 2 residents records. At 1:46 PM, LPA reviewed 2 staff records. All 2 staff are associated to the facility and have First Aid Certificate. At 2:35 PM, LPAs reviewed all of the resident’s medications. Continue to LIC809-C... Continue from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 04/24/2025: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate Infection Control Plan THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 1:58 PM, LPAs observed Lysol Spray, Clorox Wipes, and knives unlocked. At 2:00 PM, LPAs observed the hot water temperature measured at 130.8 degrees Fahrenheit. At 3:08 PM, LPAs observed that the facility does not have documentation of emergency disaster drills. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.