Routine inspection·August 9, 2024

Licensing Program Analysts (LPA) Sarah Hurt, and Martin Vega conducted an unannounced visit today for the facility’s annual inspection. LPA's met with Licensee, Irina Chernyakova, Continual Administrator's Certification expires 01/03/2025. There are currently 4 residents who reside at this home and there is 2 residents on hospice at this time. LPA's inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Smoke alarms were tested and are operational. The home has a carbon monoxide detector. Water temperature was tested at 113 degrees Fahrenheit. LPA’s observed facility fire extinguisher has not been serviced within one year. Fire extinguisher last serviced June 2023. LPA’s observed Resident 1 did not have a prescription for as needed sleep medication being administered. The facility is not performing disaster drills as required. LPA’s observed molding, and rotten vegetables inside facility refrigerator. LPA’s observed several cans of expired food stored in area used as pantry. LPA’s observed a can of Lysol kept near food inside pantry area. LPA’s observed several toxins, and chemicals including without proper labels accessible to residents. LPA’s observed Resident 1’s Physician report not updated annually as required and does not have Tuberculosis test. Facility residents do not have Pre- Admission Assessments or Needs and Services plans. LPA’s observed facility staff removes medications from original container, and places in weekly pill organizer one week prior to administering to resident. Staff 1 is fingerprint cleared, but not associated to this facility. Staff 2 does not have completed Health Screening Record (no TB test) The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Irina Chernyakova, and copy of report left at facility