Routine inspection (multi-day)·September 25, 2025

License Program Analyst (LPA) Shannan Hansen arrived unnanounced at approximately 9:00 AM to complete an annual inspection that started on 9/23/2025. LPA met with Elena Davidenko, COO/ Administrator & Will Orellana, facility director. There is a total of 112 residents. LPA and facility director conducted inspections of 12 residents apartments, retesting bathroom faucets finding hot water temperatures measured between 99.5 degrees F and 130.6 degrees F falling out of Title 22 acceptable regulation of 105 to 120 degrees F in 6 of 12 resident’s bathroom faucets, 3 of which in memory care unit, while touring facility on 9/25/2025 at 9:30 AM (see LIC809D). Although bathroom showers have required grab bars and some have mats and chairs, most showers do not have slip resistant flooring as observed by LPA and facility director. Facility director indicated will work on solution to keep residents safe from harm (see LIC9102TA). A sample review of ten resident & six staff records was conducted. LPA reviewed resident’s files at 10:30 AM on 9/25/2025 and learned that 10 out of 10 residents have an updated reappraisal/needs & care plan on file as well as medical assessments at this time as required by Title 22 Regulation. Medications were centrally stored in a locked medication cart in the facility medication room and in locked medication cart in Memory Care Unit nurses station. Medications and the process were reviewed and inspected. The facility uses electronic medication administration. LPA conducted a sample reviewed of staff records at 11:45 AM on 9/25/2025 and learned that all facility staff and other individuals who require caregiver background checks have received criminal record clearances or exemptions. In addition, Direct care staff have received the additional training requirements as per Title 22 Regulations and H&S Code. Continue on LIC809C Continued from LIC809 LPA was presented with proof of CPR & 1 st Aid certification for all staff although staff (S1) did not have proof of 1 st Aid (see LIC 809D). Record review also revealed 3 staff (S2, S3, & S4) did not have TB results and S3 & S4 did not have health screening (see LIC809D). Disaster Drills are conducted quarterly with the last one being conducted on 9/10/2025. Facility has full cite emergency generator. Elena Davidenko Administrator Certificate #7008072740 expires on 5/15/2027. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. LPA Hansen is requesting Licensee to update the following documents and submit to CCL by 10/17/2025: LIC 308 Designated LIC 309 Administrative Organization LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changes) LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurance