Shalom Elderly Care, Inc. 5

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Barutyan arrived unannounced to conduct a required annual visit at 10:08AM. LPA met with staff, Administrator Doris Almario who arrived shortly thereafter, and Licensee Dina Vetchtein who arrived at 10:32AM. Entrance interview conducted. LPA and 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 following was observed: KITCHEN/LAUNDRY/GARAGE: LPA toured the kitchen at 10:16AM. Knives and chemicals are locked inaccessible. Kitchen appliances were in operable condition. The facility had a sufficient supply of perishable and non-perishable food. The garage attached to the kitchen is kept locked and contains two (2) additional freezers and extra supplies. The laundry room by the kitchen contained locked and inaccessible cleaning supplies, disinfectants, and detergents. BEDROOMS: The facility has seven (7) bedrooms total of which four (4) are single-occupancy resident rooms, one (1) is a shared resident room, one (1) is currently rented as a private resident living room, and one (1) is a staff room. All bedrooms were furnished appropriately; beds had clean linens and rooms had sufficient lighting. All direct exits were clear, no obstructions were noted. Staff room was observed locked. 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) staff/visitor restroom located by the laundry room near the kitchen. The restrooms were clean, sanitary, and in operating condition with grab bars and slip-resistant surfaces. Hot water temperatures were measured in resident bathrooms and were between 108.3-119.3 degrees F, which is within the required range. Report Continued on LIC809-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 10:36AM 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 and bedrooms were functional and operating at the time of the visit. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for resident use. There is a side gate for resident use that is single-latched. No bodies of water noted. RECORD REVIEW: Beginning at 10:40AM, 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. MEDICATION REVIEW: At 12PM, 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 disaster plan is updated annually as required. 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 19, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Barutyan arrived unannounced to conduct a required annual visit at 10:40AM. LPA met with staff. Administrator Doris Almario arrived at 10:53AM and Licensee Dina Vetchtein arrived at 11:08AM. Entrance interview conducted. LPA and 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 following was observed: KITCHEN/LAUNDRY/GARAGE: LPA toured the kitchen at 10:53AM. Knives and chemicals are locked inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The garage attached to the kitchen is kept locked and contains two (2) additional freezers and extra supplies. The laundry room by the kitchen contained locked and inaccessible cleaning supplies, disinfectants, and detergents. BEDROOMS: The facility has four (4) single-occupancy resident rooms, one (1) double-occupancy resident room, one (1) single-occupancy resident room currently rented as a private resident living room, and one (1) staff room. All bedrooms 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) staff restroom located by the laundry room near the kitchen. The restrooms were clean and sanitary with grab bars and slip-resistant surfaces. Between 10:59AM – 11:03AM, LPA measured hot water temperatures in resident restrooms to be between 105.2 degrees F – 113.3 degrees F, which is within the required range. 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 of 72 degrees Fahrenheit. Smoke detector(s) and carbon monoxide detector were tested at 11:14AM and were operational at the time of the visit. The fire extinguisher in the kitchen was fully charged and 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. RECORD REVIEW: Beginning at 11:20AM, 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 12:33AM, 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. At 12:37AM, LPA observed three (3) medications for Resident #1 (R1) that were missing start dates on the centrally stored medication and destruction record. Two (2) out of three (3) of the medications had start dates written on the medication bottle. For the third medication, staff counted the number of pills to determine the start date. LPA observed the medications for the two (2) other residents to be properly documented. 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 disaster plan is updated annually as required. Emergency drills are conducted quarterly as is required, with the last drill conducted on 09/10/2024. Pursuant to Title 22, CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiency may result in civil penalties. Exit interview conducted, report issued, and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 14, 2024

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived unannounced to conduct a required annual visit. The LPA met with Administrator Doris Almario and explained the reason for the visit. The LPA and the 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. KITCHEN: Knives and chemicals are locked inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply for two days of perishable and a seven day supply of non-perishable food. The hot water temperature measured at 109.8 degrees Fahrenheit. Laundry room is adjacent to the kitchen. Washer and dryer were functioning at the time of the inspection. Cleaning supplies and disinfectants are kept in locked cabinets in the laundry room. BEDROOMS: The facility has six private resident bedrooms and one staff room, all which were furnished appropriately; beds had clean linens and rooms had sufficient lighting. All direct exits were clear, and no obstructions were noted. RESTROOMS: Three out of six resident rooms have a private restroom inside the room and three have restrooms outside the rooms. One common restroom is located by the laundry room. The restrooms were clean and sanitary with grab bars and non-skid surfaces. Water temperatures measured between 105.5- and 109.3-degrees Fahrenheit. Restrooms were fully stocked with hygiene paper and paper towels. Hand-washing signs were observed. COMMON SPACES: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 73 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last serviced on 10/15/2023. The LPA observed required postings throughout the common space. Continues on LIC 809C... OUTDOOR AREA/GARAGE: 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. The garage is attached to the facility with a connecting door. Door was locked at the time of the visit. RECORDS: Records review began at 11:30 a.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 1:00 p.m.; 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. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster -Liability Insurance -Emergency Drills Form No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 15, 2023