Shalom Elderly Care, Inc. 4

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Barutyan arrived unannounced to conduct a required annual visit at 10:45AM. LPA met with staff, Licensee Dina Vetchtein, and Administrator Doris Almario. Entrance interview conducted. LPA and Licensee 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 following was observed: KITCHEN: LPA toured the kitchen at 10:47AM. Knives and chemicals are locked inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: The facility has six (6) single-occupancy resident rooms and two (2) staff rooms, all of which were furnished appropriately. Staff rooms were observed locked. Beds had clean linens and rooms had sufficient lighting. All direct exits were clear, and no obstructions were noted. RESTROOMS/LAUNDRY: The facility has seven (7) total restrooms, six (6) are designated for resident-use and one (1) is designated for staff and visitor use. Five (5) out of six (6) resident bedrooms have an attached restroom, there is one (1) private restroom in the hallway, and one (1) common restroom located by the laundry room near the kitchen. LPA observed bathrooms to be clean, sanitary, and in operating condition with slip-resistant surfaces and grab bars. Hot water temperatures were measured in resident bathrooms and were between 105.3-115.2 degrees F, which is within the required range. The laundry room contained locked and inaccessible cleaning supplies, disinfectants, and detergents. Report continued on LIC 809-C. COMMON AREAS: These include the living room and dining area. All common areas were observed to be in good condition. There is a screened and inaccessible fireplace in the living room. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were tested at 11:11AM and were operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last purchased on 09/18/2025. LPA observed required postings throughout the common areas. Hallways contained supply closets with extra linens and emergency food and water supply. All auditory exit devices in common areas were functional and operating at the time of the visit. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single-latched. No bodies of water noted. RECORD REVIEW: Beginning at 11:22AM, LPA reviewed six (6) out of six (6) resident and three (3) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All resident and personnel files were in order. MEDICATION REVIEW: At 12:30PM, LPA reviewed medications for two (2) residents. Medications are centrally stored and locked in a cabinet in the kitchen area. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs were properly documented and logged. Medications were observed to be properly documented on the centrally stored medications and destruction record and were in compliance with regulation, state, and federal law. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency drills are conducted quarterly as is required, with the last drill conducted on 09/05/2025. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 5, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Barutyan arrived unannounced to conduct a required annual visit at 10:06AM. LPA met with staff and Licensee/Administrator Dina Vetchtein at 10:20AM. Entrance interview conducted. LPA and Licensee 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 following was observed: KITCHEN: LPA toured the kitchen at 10:09AM. Knives and chemicals are locked inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: The facility has six (6) single-occupancy resident rooms and two (2) staff rooms, all of which were furnished appropriately; beds had clean linens and rooms had sufficient lighting. All direct exits were clear, and no obstructions were noted. RESTROOMS: The facility has seven (7) restrooms. Five (5) out of six (6) resident bedrooms have an attached restroom, there is one (1) private restroom in the hallway, and one (1) common restroom located by the laundry room near the kitchen. The restrooms were clean and sanitary with grab bars and slip-resistant surfaces. During 10:17AM – 10:20 AM, LPA measured hot water temperatures at 103.3 degrees F – 103.6 degrees F, which is slightly under the required range of 105 degrees F – 120 degrees F. Licensee stated they will increase the water heater. The laundry room contained locked and inaccessible cleaning supplies, disinfectants, and detergents. Report continued on LIC 809-C. COMMON AREAS: These include the living room and dining area. All common areas were observed to be in good condition. There is a screened and inaccessible fireplace in the living room. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were tested at 11:37AM and were operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last purchased on 10/21/2024. LPA observed required postings throughout the common areas. Hallways contained supply closets with extra linens and emergency water supply. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single-latched. No bodies of water noted. MEDICATION REVIEW: At 10:32AM, LPA reviewed medications for three (3) residents. Medications are centrally stored and locked in a cabinet in the kitchen area. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors were observed during the medication review. RECORD REVIEW: Beginning at 10:56AM, LPA reviewed five (5) out of five (5) resident and three (3) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All resident and personnel files were in order. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency drills are conducted quarterly as is required, with the last drill conducted on 09/10/2024. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 13, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.