Routine inspection·February 21, 2025

Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:45 a.m. Upon arrival, LPA Mosley was greeted by staff and called the Administrator to inform them of the visit. The Administrator arrived shortly after. The LPA met with Co- Administrators Elina Root and Ruslan Melnikov and explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS : At the time of the visit, furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. At 1:10 p.m., smoke detector(s) and carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguishers were observed and fully charged on 2/21/2025. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 12/1/2024 and conducted quarterly. Activities were observed in the common areas. An adequate supply of emergency water was observed in dining room area. An adequate amount of extra bedding and towels were observed in a hallway closet for resident use. The facility has a working telephone on premises. Auditory alarms on all doors were functional at the time of the visit. Entry/exits were free of obstruction. KITCHEN: The LPA inspected the kitchen/food service area at 10:20 a.m. Knives and sharps were observed in a locked cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 115.1 degrees Fahrenheit at 10:21 a.m. Cleaning solutions, toxins, chemicals, and hazardous items were inaccessible and locked away inside a kitchen cabinet under the sink. Report Continued on LIC 809C... Report Continued from LIC 809... BEDROOMS: The facility is a single-story residential home with six (6) bedrooms that are for resident use. Resident bedrooms are private, single occupancy. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Inside temperature was maintained at a comfortable level. The laundry units, and cleaning solutions, are kept in the locked laundry room / staff bathroom. BATHROOMS: The facility has a total of three (3) bathrooms. Two (2) are resident bathrooms of which one (1) is a shared resident use, one (1) is a private resident use, and one (1) for staff use. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. Hot water was measured in resident bathrooms. The shared bathroom measured at 132.1-degree Fahrenheit at 10:46 a.m. and the private bathroom at 135.1-degree Fahrenheit at 10:39 a.m. both over the required temperature of 105–120-degree Fahrenheit posing an immediate health and safety risk to persons in care. At the time of the visit the Administrator was able to adjust the water temperature and get it to the required range of 105–120-degree Fahrenheit with a temperature of 115.1 at 2:35pm. The sinks had sufficient liquid soap, and paper towels. OUTDOOR SPACE/ GARAGE: The LPA observed the back yard which had a shaded patio area with patio furniture including a table and chairs for resident use. The LPA observed one gate that self-latches with a clear passageway in case of an emergency. There were no bodies of water observed on the premises at the time of the visit. The garage is kept locked and inaccessible to residents. LPA observed an adequate amount of emergency food stored in the garage. LPA observed an extra refrigerator with extra food that was checked for proper labels and expiration dates. RECORDS : Records review began at 10:57 a.m., six (6) resident records were reviewed for, but not limited to: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Record review revealed that Resident #2 (R2) was missing their TB results and Resident #4 (R4) and Resident #6 (R6) were missing an updated needs and services plan posing a potential health and safety risk to persons in care. At 12:00 p.m. four (4) Personnel records including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Report Continued from LIC 809C... Report Continued from LIC 809C... INTERVIEWS : One (1) staff and two (2) resident interviews were conducted during the inspection. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. MEDICATIONS: Medications review began at approximately 12:51 p.m. Medications are centrally stored and locked in a kitchen cabinet; medications are labeled and were checked for expiration dates. During the medication review the LPA and Administrators observed that the medications were prepped two (2) days in advance for all six (6) residents which poses a potential health and safety risk to persons in care. Documents obtained during the visit include: LIC 500 facility roster, LIC 9020A Resident roster, and current Liability Insurance. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. The Licensee was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.