Routine inspection·December 9, 2025

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced required annual inspection visit. LPA was greeted by Administrator Liubov Shevtsova and the purpose for the visit was explained. The facility is licensed to serve six (6) elderly residents ages 60 and above, of which five (5) may be non-ambulatory, one (1) may be bedridden, and has a hospice waiver approved for three(3) residents. The facility is a single-story home located in a residential area of Glendora. The home consists of a living room, dining area, kitchen, four (4) resident bedrooms, two (2) bathrooms, one (1) staff bedroom, a shaded patio in the backyard and an attached garage with laundry. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environmental Safety: The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded area located in the backyard with sufficient seating for residents in care. Passageways and exits are free of obstructions. continued on LIC 809C continued from LIC 809 (page 2) The water temperature was tested in bathroom #1 in the hallway and measured 127.5 degrees F, which is above the required 105 degrees F - 120 degrees F. Bathroom #2 water temperature measured 126.1 degrees F. Administrator adjusted the water temperature at time of visit. LPA observed grab bars and non-skid mats. Resident bedrooms all have required furniture which includes, for each resident, a bed, a chair, nightstand, and lights sufficient for reading. Resident beds have the required linen and linens were observed to be in good repair. There is closet storage space for clothing and other belongings. Hallway cabinet contained PPE supplies, surplus hygiene supplies and extra, clean linens. Smoke detectors were observed throughout the facility and are operable. There is a carbon monoxide detector located in the kitchen, was tested and is operable. There are two (2) fire extinguishers located in the kitchen, and garage. Emergency drills conducted quarterly, last drill conducted 08/25/25. All kitchen areas observed clean and free of litter, rodents, vermin and insects. Kitchen appliances such as refrigerators, stove and microwave are clean and were operating at the time of the visit. Sharps are locked in a kitchen drawer and are secured, inaccessible to residents. Cleaning supplies and disinfectants are secured under the sink and are inaccessible to the residents and separate from food supply. Sufficient supply of 2 days perishable and 7 days non-perishable foods were observed. Containers storing waste are in good repair and free of leaks. Telephone service on the premises Dining area and living room are clean and free of obstructions and have sufficient seating for residents in care. Attached garage has laundry area. Washing machine and dryer wear clean and operable at the time of visit. There is a cabinet with laundry supplies. Staffing: Administrator and two (2) staff have current CPR training. Staffing sufficient in number and competent to meet resident need. LPA observed training logs for all staff. continued on LIC 809C page 3 Personnel Records- training: LPA reviewed files for three (3) staff. Personnel record maintained for each employee to contain the following: criminal record clearance, first aid/CPR, fingerprint clearance, personnel record, health screening, TB test Residents Rights: Personal Rights are posted. Planned Activities: LPA observed board games and books for resident use. Resident Records/Incident Reports: LPA reviewed three (3) resident files. Each file contained admission agreement, recent medical assessment, ambulatory status, medical consent form, identification/face sheet, appraisal needs and service plan. File for R1 did not contain TB clearance, deficiency cited. Medications are centrally stored in the secured in a locked kitchen cabinet. Medications are documented properly and given as prescribed. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809D. Exit interview held and a copy of the report along with appeal rights were provided to the Administrator Liubov Shevtsova.