Routine inspection·August 12, 2025

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 11:24AM. LPA met with Head Caregiver (HC) Dexter Olavario. Administrator Belinda Dolinsky could not be on site at the time of the visit, but Dexter Olavario was designated to sign in their place. Entrance interview conducted. Beginning at 11:26AM, the LPA, along with the HC toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguishers were fully charged and last serviced 07/24/2025. Hardwired smoke detectors and carbon monoxide detector in kitchen were tested at 11:45AM and all were functional at the time of the visit. LPA observed exit alarms by all doors which were functional and operating. KITCHEN/GARAGE: LPA inspected the kitchen at 11:26AM. Knives and sharps were stored in a locked drawer. Kitchen appliances were in operable condition. The facility had a sufficient supply of perishable and non-perishable food. LPA observed emergency food and water supply in the pantry next to the kitchen. Food was stored at appropriate temperatures. The locked garage is accessed through the kitchen. LPA observed an additional refrigerator/freezer and cleaning supplies in the garage. BEDROOMS : The facility consists of eight (8) total bedrooms, of which six (6) are designated for single-resident use and two (2) are designated for staff use. All resident rooms have exits to the exterior. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Report Continued on LIC 809-C BATHROOMS : There are six (6) total bathrooms, of which five (5) are attached to resident rooms and 1 (one) is for common use. LPA observed bathrooms to be clean, sanitary and in operating condition with grab bars and slip-resistant surfaces. Hot water temperatures were measured in three (3) bathrooms and were between 105.6 F-119.8 degrees F, which is within the required range. COMMON AREAS/LAUNDRY : This includes the living room, exercise room, and dining room. LPA observed common areas to be clean and properly furnished at the time of the visit. LPA observed a fireplace in the living room that was adequately screened. Facility was maintained at a comfortable temperature. LPA observed surveillance cameras in the common areas. LPA observed storage space closets in hallway containing clean linens for resident use. LPA observed the laundry room adjacent to the staff room. Laundry room had a washer and dryer and locked cleaning supplies. OUTDOOR SPACE: The backyard had a covered patio area with furniture including a table and chairs. There were no bodies of water on the premises. One (1) side pathway is used as an emergency exit which was free of obstruction and had a self-closing and self-latching gate. RECORD REVIEW: LPA began record review at 11:52AM. LPA reviewed six (6) out of six (6) resident files and four (4) staff files for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. LPA observed half rails in five (5) resident rooms and full rails in one (1) resident room. Five (5) resident files were missing the half bed rail orders, and one (1) resident file was missing full rail orders and the resident was not receiving hospice services. Staff files were complete and had no missing documents. MEDICATION REVIEW: Medications are centrally stored and locked in a cabinet in the kitchen. LPA began medication review at 01:05PM and medications for two (2) residents were observed. All medications were labeled and maintained in compliance with label instructions, and state and federal law. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drill was conducted during the visit. Pursuant to Title 22, CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiency may result in civil penalties. Exit interview conducted, report issued, and appeal rights provided.