Routine inspection·September 16, 2025

License Program Analyst (LPA) Hansen arrived unannounced to conduct an Annual Required – 1 yr. visit of the facility. LPA was welcomed by Administrator Natalia Meyerson. Facility is single story with a loft for staff use only with four (4) resident bedrooms & three (3) bathrooms, with a fire clearance approved for 8 Non-Ambulatory, hospice waiver for 4, and secured perimeter. At today’s inspection there is a total of 6 residents with no residents currently on Hospice. LPA toured the facility on 9/16/2025 at 8:20 AM with administrator; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguishers were found to be last charged on 8/8/2025 at the time of the visit. Facility smoke detectors are hard wired and sound directly to contracted company which are inspected annually, last being 9/12/2025. LPA observed carbon monoxide detectors to be operational during the visit. Facility has a generator that will start if there is a power shut off. Hot water temperature measured between 115.3 degrees F and 117 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 3 of 3 resident’s bathrooms while touring facility on 9/16/2025 at 8:50 AM. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations at the time of the visit. Food is available for residents any time of the day. There are activities schedule for residents' weekly. Toxins are stored in locked bathroom cabinets, locked kitchen cabinet under sink, and garage. There was a supply of cleaners, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars, and slip-resistant mats, strips, or flooring in all bathtub and shower floors as required by Title 22 regulations. A sample tour of resident’s bedrooms was conducted, and bedrooms inspected have lighting & appropriate furnishing. Continue LIC 809-C Continued from LIC809 A sample review of five residents & three staff records as well as two resident’s medications was conducted. LPA reviewed a random sample of resident’s files at 9:40 AM on 9/16/2025 and learned that 3 out of 6 residents (R1,R2 &R3) do not have an updated reappraisal/needs/care plan on file (see LIC809D). 6 out of 6 residents have medical assessments at this time as required by Title 22 Regulation. Medications were centrally stored in a locked medication cabinet in the facility medication room. The Medications of 1 out of 2 residents records of medication counts according to physicians’ directions did not match on 9/16/2025 at 11:15 AM. Centrally Stored Medication Record (CSMR) of 1 out of 2 residents were found to be inaccurate (see LIC 809D). LPA conducted a sample reviewed of staff records at 10:15 AM on 9/16/2025 and learned that all facility staff and other individuals who require caregiver background checks have received criminal record clearances or exemptions. Direct care staff have received the additional training requirements as per Title 22 Regulations. LPA was presented with proof of CPR & 1 st Aid certification for staff; although 1 of 3 staff records reviewed does not have required updated First Aid certification (see LIC809-D). Natalia Meyerson Administrator Certificate # 7004868740 expires on 5/17/2026. Disaster Drills have been conducted quarterly/in different shift with the last one being on 8/25/2025. 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 and submit the following documents by 10/3/2025: LIC 500 Personnel Summary LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurance