Routine inspection·June 18, 2025

On June 18, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Shimon Cagan was present and assisted LPA with the inspection. LPA observed that Shimon Cagan has a valid Administrator certificate which expires on November 21, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for four. The facility is a two story home with five private resident bedrooms, two shared resident bathrooms, a living room, a dining room, a kitchen, a sun room, and an attached two car garage. LPA, accompanied by the AD, conducted a tour of the interior portions of the facility. On today's visit, LPA observed five residents in care and three care giving staff present. LPA observed residents eating lunch in their respective bedrooms and in the sun room. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected the five resident bedrooms and observed them to be free of hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the two shared resident bathrooms and they were observed to be free of hazards. Resident bathrooms were equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 116.7 to 118.2 degrees Fahrenheit. LPA observed the second story of the home to be off limits to residents in care. LPA observed a staff office on the second story which is kept locked and inaccessible to residents in care. CONTINUED ON 809-C LPA observed the kitchen has a two day perishable and a seven day non-perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. The five burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. LPA observed fire extinguishers to be mounted on the wall in the dining room and in the resident hallway. Fire extinguishers were observed to be charged and serviced as of May 9, 2025. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on March 27, 2025. LPA observed oxygen signs to be posted in the appropriate areas. The centrally stored medication is kept in a locked cabinet in the dining room. A First Aid Kit is stored in the locked closet and it was observed to have all the required components. LPA observed a fire place in the living room and it was adequately fenced and not in operation at time of visit. LPA observed the sun room to be clear of any obstructions or hazards. LPA observed the door leading to the attached two car garage to be kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by the AD, conducted a tour of the exterior portion of the facility which was observed to be free of hazards. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gates of the facility to be self latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all five resident files. All the required documentation was present and current in the resident files reviewed. LPA reviewed residents' medication and medication administration records. LPA reviewed three staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, no deficiencies are being cited per the Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Shimon Cagan and a copy of the report was provided.