Follow-up on corrections·June 19, 2025

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced CASE MANAGEMENT visit to this facility in conjunction with a complaint. The purpose of this Case Management visit is to issue citations for deficiencies discovered during the course of the complaint investigation that is not directly related to the complaint allegation. During today’s visit, LPA spoke with Staff / caregiver Iuliia Palchikova who called the Administrator to inform them of the visit. The Administrator was unable to attend and designated staff Iuliia Palchikova to sign the report. LPA explained the reason for the visit. During interview with Staff #1 (S1) revealed that sometime time early in June 2025 the exact date is unknown the facility was over capacity and had seven (7) residents. LPA observed the facility license which state that the facility’s total capacity is six (6). Facility does not have fire clearance for more than six (6) clients. File review conducted at 10:42 a.m. revealed that all six (6) current residents residing at the facility had an admission date prior to June 2025. Interview with S1 revealed that Resident #1 (R1) was brought to the facility sometime early in June 2025 the exact date is unknown via transportation service from Kaiser. S1 noted that they were unaware why the resident was brough to the facility as they were at full capacity with six (6) residents however still allowed the resident to stay which poses / posed an immediate health, safety or personal rights risk to persons in care. LPA discussed section Title 22 section 87202 Fire Clearance, 87204 Limitations - Capacity and Ambulatory Status and the importance of not operating a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. Report continued on LIC809-C... (PAGE 2) Report continued from LIC 809... Interview also revealed that the facility accepted R1 without any proper documentation including preadmission appraisal and all the proper documentation needed prior to acceptance which poses / posed an immediate health, safety or personal rights risk to persons in care. LPA discussed the importance of Title 22 requirements for proper documentation and assessments needed prior to accepting residents. Furthermore, LPA discussed the Regulations regarding Eviction Procedures for RCFE stated Thirty (30) days written notice to the resident is required for California Code of Regulations (CCR) Section 87224(a)(1) through (4). These are nonpayment of the rate for basic services, failure to comply with state or local law, failure to comply with the general policies of the facility, and development of a resident need not previously identified. Sixty (60) days written notice is required for Section 87224(a)(5). This is the eviction of a resident due to change of use of the facility. The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Civil penalty was assessed in the amount of $500 for fire clearance violation. Administrator was informed that failure to correct the deficiency may result in additional civil penalties. Exit interview conducted. A copy of the report and appeal rights provided.