Routine inspection·March 13, 2025

Licensing Program Analysts (LPAs) Contreras and Cuadra arrived unannounced to conduct the required 1-year annual inspection. LPAs met with Lisa DiBartolo, Administrative Assistant. The facility has residents receiving hospice services and residents with Dementia diagnoses. Annual fees are current. Required postings were observed. Contact information was reviewed. Upon arrival, LPAs/staff noticed one gallon of detergent and 11 bottles of cleansers sitting on reception area accessible to residents. There were three staff around the reception area (technical advisory issued). LPAs/staff toured the facility inside and outside at approximate 9:30am: Facility has a centralized fire alarm system that is maintained by a vendor and inspected by the local fire department. Facility's last maintenance was conducted 12/19/24. Facility has a locked perimeter. Smoke detectors, sprinklers, carbon monoxide detectors were present throughout the facility. Fire panel was last inspected 12/19/2024. Last disaster drill was conducted on February 2025. The facility is a one story building and has an approved fire clearance dated September 26, 2024 that allows for 34 ambulatory and 28 non-ambulatory residents and no bedridden resident. However, during records review two (R1 and R2) out nine residents have a bedridden status and are occupying room #1 (R1) and room #19 (R2), which are not cleared by the Fire Department as bedridden rooms. Licensee is operating outside the limitation of the license by accepting a bedridden resident in a non-ambulatory room. LPA/staff discussed the issue with R1 and R2 to provide the option to submit a request to the Fire Marshall to assess bedrooms to grant fire clearance. According to the Administrative Assistant, R1 and R2 are not bedridden and they have reached out during LPAs vitis to both physicians to obtain an updated physician's report (LIC602). During the visit, LPA spoke with R1 and R2 who expressed that they are not fully bedridden and they are in agreement to obtain an updated medical assessment. Fire Extinguishers were last serviced February 2024. As a result of the fire clearance violation, an immediate civil penalty in the amount of $500 is issued today. Continue on LIC809C... Continued from LIC809... At approximate 9:45am LPAs pulled emergency alerts in resident's room (#5) and staff did not respond in a timely manner. According to Administrative Assistant, it appeared that the system was not on, so it did not alert staff to respond to call alerts. However, after the system was on, LPAs pulled the call alerts again and staff responded timely. At approximate 9:50am LPAs/staff observed auditory alarms in room #7 and #4 resident bedrooms sliding glass door exits were not activated (technical violation issued). At approximate 10:00am LPAs/staff observed bathroom toilet in room 7 found cracked and staff placed out of order sign, sticky floor observed throughout facility and trash can with no lid was observed in bathroom room 20, Bathroom in room 12 observed with feces on floor in shared bathroom. Chairs in some resident's bedrooms were not available. At approximate 10:05 am LPAs/staff observed unpacked dry goods with no expiration dates noted. Also, LPAs observed that residents were being served hot dogs, mashed potatoes and salad for lunch. LPAs held a conversation with staff regarding the importance to serve residents with nutritious food. At approximate 10:10am LPAs/staff did not observed toilet paper and paper towels available to resident's in shared bathrooms. Facility had sufficient perishable and non-perishable food. LPAs initiated file review at 11:00am. Nine residents and five staff files were reviewed. Residents have their care plan and medical assessments updated. Staff do have annual required training hours completed and at least one staff per shift have current CPR. During file review, LIC500 revealed that 2 out of 27 staff were cleared, but they were not associated to facility; LPA informed staff that the staff should never be working and providing care to residents prior to a criminal record clearance or exemption. Civil penalties are being assessed in the amount of $500 for allowing a person to work, reside or volunteer in the facility without a been associated to the facility. Administrator certificate for administrator Alex Varshavsky 7019479740 expires 7/15/26. At approximately 12:30pm a spot check of medications were conducted and 2 out 5 residents (R2 and R3) medications were not given to residents according to their physician's order. Licensee to submit updates of the following documents by 3/27/25: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), control of property and Liability Insurance. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with Administrative assistant who was informed that the Department will be reviewing if further action is needed to address the overall compliance of the facility and a copy of this report was given.