Routine inspection·September 4, 2025

Licensing Program Analyst (LPA) Sommer Hayes arrived unannounced to conduct a Required - 1 Year visit on 9/4/2025 Administrator certificate expires 01/15/2027 for Valentina Marinova. LPA Hayes met with Valentina Marinova and stated the purpose of today’s visit. The facility is licensed for a capacity of 6. The census was 5. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables. The most recent emergency drill was conducted on 08/25/25 at 1:00pm with 5 residents and 4 staff. The temperature inside the facility was observed to be at 77*F, which is within the required range of 68-85*F. The hot water temperature was measured at 105.8 *F which is within the required range of 105-120*F. LPA observed a fire extinguisher serviced 08/15/25 by Jorgensen Co., smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. Medications and the medication administration record (MAR) was reviewed and was found to have inaccurate documentation and medication errors for medications provided to residents. Staff were observed tending and cooking for residents in care. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and a guide. Continued on an 809-C LPA Hayes observed the backyard of the facility to be clean and free of hazards. There were shaded areas and grape vines for residents to enjoy. Fencing was in good repair. There were no bodies of water. The facility living room was clean and free of obstruction. LPA Hayes requested the following annual documents for the facility file: LIC 500 Personnel Report, LIC 308 Designation of Responsibility, LIC 610 Emergency Disaster Plan, LIC 999 Facility Sketch, Copy of Liability Insurance, Admissions Agreement, Copy of Administrator’s Certificate. Per California Code of Regulations (CCR) - Title 22, 1 deficiency is being cited. An exit interview was held, and a copy of the report was provided to Administrator, Valentina Marinova.