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Inspection visit

Routine inspection

SHALOM ELDERLY CARE, INC. 5License 1976086541 citation on this visit
1 citation recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Angela Barutyan arrived unannounced to conduct a required annual visit at 10:40AM. LPA met with staff. Administrator Doris Almario arrived at 10:53AM and Licensee Dina Vetchtein arrived at 11:08AM. Entrance interview conducted. LPA and Administrator 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. The following was observed: KITCHEN/LAUNDRY/GARAGE: LPA toured the kitchen at 10:53AM. Knives and chemicals are locked inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The garage attached to the kitchen is kept locked and contains two (2) additional freezers and extra supplies. The laundry room by the kitchen contained locked and inaccessible cleaning supplies, disinfectants, and detergents. BEDROOMS: The facility has four (4) single-occupancy resident rooms, one (1) double-occupancy resident room, one (1) single-occupancy resident room currently rented as a private resident living room, and one (1) staff room. All bedrooms were furnished appropriately; beds had clean linens and rooms had sufficient lighting. All direct exits were clear, and no obstructions were noted. RESTROOMS: The facility has seven (7) restrooms. Five (5) out of six (6) resident bedrooms have an attached restroom, there is one (1) private restroom in the hallway, and one (1) staff restroom located by the laundry room near the kitchen. The restrooms were clean and sanitary with grab bars and slip-resistant surfaces. Between 10:59AM – 11:03AM, LPA measured hot water temperatures in resident restrooms to be between 105.2 degrees F – 113.3 degrees F, which is within the required range. Report continued on LIC 809-C. COMMON AREAS: These include the living room and dining area. All common areas were observed to be in good condition. There is a screened and inaccessible fireplace in the living room. The facility maintained a comfortable temperature of 72 degrees Fahrenheit. Smoke detector(s) and carbon monoxide detector were tested at 11:14AM and were operational at the time of the visit. The fire extinguisher in the kitchen was fully charged and last purchased on 10/21/2024. LPA observed required postings throughout the common areas. Hallways contained supply closets with extra linens and emergency water supply. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single-latched. No bodies of water noted. RECORD REVIEW: Beginning at 11:20AM, LPA reviewed six (6) out of six (6) resident and three (3) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All resident and personnel files were in order. MEDICATION REVIEW: At 12:33AM, LPA reviewed medications for three (3) residents. Medications are centrally stored and locked in a cabinet in the kitchen area. Medications are labeled and checked for expiration dates. At 12:37AM, LPA observed three (3) medications for Resident #1 (R1) that were missing start dates on the centrally stored medication and destruction record. Two (2) out of three (3) of the medications had start dates written on the medication bottle. For the third medication, staff counted the number of pills to determine the start date. LPA observed the medications for the two (2) other residents to be properly documented. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency drills are conducted quarterly as is required, with the last drill conducted on 09/10/2024. 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.

Citations

1 citation recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87465(h)(4)Type B

    Based on medication review, the licensee did not comply with the section cited above as three (3) medications for Resident #1 were missing start dates on the centrally stored medication and destruction record which posed a potential health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the November 14, 2024 inspection of SHALOM ELDERLY CARE, INC. 5?

This was a inspection inspection of SHALOM ELDERLY CARE, INC. 5 on November 14, 2024. 1 citation were issued: 1 Type B.

Were any citations issued to SHALOM ELDERLY CARE, INC. 5 on November 14, 2024?

Yes, 1 citation was issued (0 Type A, 1 Type B). The first citation was for: "Based on medication review, the licensee did not comply with the section cited above as three (3) medications for Reside..."

What type of inspection was this?

This was a inspection inspection. inspection inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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