Routine inspection·October 1, 2025

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a required Annual inspection and met with Administrator/Licensee Alex Varshavsky. There are currently five residents receiving hospice services. Annual fees are current. Required postings observed. At approximately 9:30am LPA/Administrator toured the building and grounds. The facility was found to be clean and common areas of facility was at comfortable temperature. LPA observed at least two-day supply of perishable and seven-day supply of non-perishable food. Food items were found to be stored and handle in a health and safe manner with open items were labeled with dates . All bedrooms were furnished per regulation. LPA inspected areas of concern from the last annual, items including night lamps, broken windows, fireplace screen, shower curtains and adequate bed springs were found within compliance . Extra hygiene products and linens were available. Resident bathrooms all had grab bars and mats were observed. Water temperature in sink accessible to residents in care in bathroom measured at 109.8 and 110.7 degrees F which is within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 10/23/2024. During the tour of the facility, LPA pulled the call alert pendant from a resident's room, then staff was alerted by the sound and arrived timely to assist resident. Smoke/Carbon Monoxide detectors located throughout the facility are hardwired and serviced quarterly by Nemesis Fire, last serviced on 6/12/25. Facility’s last quarterly disaster drills were conducted 7/18/2025. Facility has a backup generator for use during a power outage. Auditory alarms were working properly. Activities and menu calendar were posted. Continue on LIC809C... Continued from LIC809... LPA initiated file review at 10:10am of ten residents and six staff records. Two out of ten residents (R1 & R2) care plan was updated, but not signed by resident's responsible party. According to Licensee, their responsible parties are hard to get a hold of them, but LPA have advice the Licensee to document their attempts. All six staff have required CPR/1st aid certificates and 20 hours of annual training completed. LPA confirmed that the facility is using the department's approved vendor for training materials. Alex Varshavsky Administrator Certificate 7019479740 expires 7/15/2026. At approximately 12:30pm LPA/Med Tech conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. LPA observed that the facility have implemented a system of adding start dates to bottles and list on Centrally Stored Medication Log as suggested as best practices by LPA. Licensee agreed to submit updated copies of the following by not later than 10/15/25: LIC500- Personnel Report, LIC308- Designation of Responsibility and copy of Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given.