Pre-licensing visit·December 11, 2025

At 10:00 am Licensing Program Analyst (LPA) Tihesha Smith made a subsequent announced visit to this facility to conduct Pre-licensing inspection. LPA was greeted by the Licensee and administrators (CA Identification verified.) LPA Smith attempted initial pre-licensing inspection on 10/30/2025 and rescheduled to 11/13/2025. This licensing application is a plan of correction to unlicensed operation that was substantiated under complaint # 31-AS-20241022130708 on 10/29/2024. The home is single story and has four (4) bedrooms/each with its own bathroom and 1(one) guest bath for a total of five (5) bathrooms. The common areas (kitchen, dining, and living room/office areas) were appropriately furnished, and lighting was adequate. Refrigerator stocked with adequate food supply. Freezer in hallways stocked with meats/poultry. Pantry closet stocked with canned foods, dry foods and ready meals. The appliances in the kitchen appeared to be functional. The sharps and first aid kit are stored and locked in hallway standalone cabinet near medications. The living room has a television and comfortable furniture. Games and activities for residents are stored on the living room console table. There are two (2) wall mounted fire extinguishers in the home: One (1) dining room and one (1) in hallway located near bedroom #4. Both fire extinguishers observed to be fully charged. Dual Smoke and Carbon Monoxide detectors were observed all over the facility, tested, and observed to be operational at 02:34 pm. Posting requirements in the living room and near front door. Bedrooms have required furniture but need to be relocated. Extra linen/supplies stored on shelving in hallway. The hot water was tested for the bathrooms to be at 109. °F. Bathrooms have trash cans with lids, hand soap and paper towels, grab bars only in bathroom # 4. Medications stored and locked in hallway standalone. Facility files stored in small office cabinet. Toxins locked in guest bathroom standalone cabinet. Laundry room in hallway and the appliances were observed to be in good repair. Covered patio with table and sufficient seating for residents to conduct outdoor activities. Pool on property enclosed by fenced and observed to be locked an inaccessible. Facility observed to be clean and in good repair. Component III was conducted with the administrator (Elena Kordonskiy) and understanding of Title 22 requirements confirmed by the administrator. The following items identified need to be corrected: The usage of the bedroom’s will be corrected on the facility sketch and sent to CAB specialist Bedroom #1 has two individuals in room will be a shared room Bedroom #1 Bathroom: Add grab bars and skid mats Bedroom #2 will be the staff room---- Licensee will remove additional bedroom room sleeping arrangement out of the closet and relocate to bedroom # 3 Bedroom #2 bathroom: Add grab bars and skid mats Bedroom #3 bathroom: Add grab bars and skid mats Bedroom #4 is bedridden Guest bathroom: Add grab bars Elena Kordonskiy will be the administrator/ Licensee will send administrators certificate to CAB Specialist Licensee has power of attorney (POA) for an individual that she stated will be a resident. Licensee will need to provide notarized POA revocation form Copy of this report will be forwarded to the CAB specialist. Exit interview conducted/Copy of report given.