Routine inspection·December 5, 2024

Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Nelli Khlebnikova, Administrator and the purpose of the visit was discussed. Facility is licensed to serve 6 non- ambulatory residents and an approved hospice waiver for 1 resident. None of the residents are diagnosed with dementia or receiving home health or hospice care services at time of visit. The facility does not handle any of the residents’ money. This home is a single story home consisting of: (6) resident bedrooms, (3) Full bathroom, living room, kitchen with dining room, laundry room (located in the hallway) and an outdoor shaded patio area. LPA toured the Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 107 F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. Deficiencies cited under California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiencies: See 809-C and D - On 12/5/24 LPA reviewed Staff #2 and Staff #4 records. LPA observed the records are incomplete. Staff #2 and Staff #4 files did not contained the physicians report. An exit interview was conducted, Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with, Alisa Nadzina, Administrator Assistant .