Routine inspection·November 19, 2025

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct the required annual visit at 10:15 A.M. LPA initially met with facility staff. Administrator, Amanbek Atakeev, was contacted via telephone and arrived at 10:45 A.M. Back-up administrator, Gulira “Gigi” Atakeeva, arrived shortly after. The reason for the visit was explained. Entrance interview conducted. Beginning at 11:20 A.M., the LPA, along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. The following was observed: COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. A fireplace was observed to be inaccessible to residents in care. The facility maintained a temperature of 69 degrees. Facility provides sufficient space to accommodate both indoor and outdoor activities. LPA observed a working phone available for residents use whenever needed. All hard-wired combination smoke alarm and carbon monoxide detectors were tested at 11:40 A.M. and function properly at this time. Fire extinguishers were observed to be fully charged and last serviced on 11/21/2025. The two (2) common living and dining areas are clean and properly furnished. LPA observed cameras in the common areas and outside perimeter of the property. Hygiene products were observed to be in a locked hallway closet. Continued on LIC 809-C Continued from LIC 809 BEDROOMS: The facility has seven (7) bedrooms in total; six (6) are designated for resident use and one (1) is designated for staff use. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: The facility has four (4) bathrooms, one (1) is located in the hallway and is designated for shared use and three (3) are for private resident use. Resident restrooms were observed to be clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. Between 11:22 A.M. and 11:38 A.M. hot water was measured in all resident restrooms and measured within the required range of 105 - 120 degrees Fahrenheit. KITCHEN : The kitchen contained a sufficient supply of dishes, glasses and utensils. A seven-day supply of non-perishable food is present. Kitchen appliances appeared to be in operable condition. Knives were observed to be stored in a locked drawer and cleaning supplies were locked under the kitchen sink. At 11:45 A.M. hot water measured at 114.1 degrees Fahrenheit. LAUNDRY ROOM/GARAGE: Adjacent to the kitchen is a locked garage. Inside the locked garage LPA observed a washer and dryer, three (3) extra fridges with extra food for residents and staff, extra cleaning and PPE supplies, and extra storage room. Additionally, there was a sufficient amount of emergency food and water at the time of the visit. OUTDOOR SPACE: The backyard has a covered outdoor area equipped with furniture for residents’ use. All exits and passageways were observed to be free of hazards. There were no bodies of water noted. Facility has two total gates; both were observed to be self-latching and closing with clear passageways for emergency exit use. A locked shed containing gardening tools was observed. RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. At 12:25 P.M. LPA reviewed five (5) resident records. All records were complete. At 1:09 P.M. LPA reviewed five (5) staff files including Administrator’s and observed that Staff #1 (S1) has a complete Health Screening Report (LIC503) indication they are able to work without restrictions; however, the tuberculosis (TB) test result was not available for review. The administrator reported that an X-ray had been completed prior to S1’s hire to clear them for employment, but the corresponding X-ray documentation could not be located during the visit. Continued on LIC 809-C Continued LIC 809-C MEDICATION REVIEW: At 2:15 P.M. medications for five (5) residents were observed. Medications are centrally stored and locked in a cabinet in the kitchen. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. During today's visit, LPA gathered the following items: Personnel Record (LIC500), Facility Roster (LIC9020A), a copy of the facility's current liability insurance, and the current Emergency and Disaster plan. Emergency disaster drills are conducted quarterly, with the last drill documented on 08/01/2025. Technical Advisory (TA) Issued. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.