Shalom Elderly Care, Inc. 6

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Barutyan arrived unannounced to conduct a required annual visit at 11:30AM. LPA met with staff upon arrival and Licensee Dina Vetchtein and Administrator Doris Almario who arrived shortly thereafter. 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 11:35AM with staff. 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 one (1) staff room, 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. Auditory exit alarms in all bedrooms were functional and operating. Staff room was kept locked and inaccessible during the visit. RESTROOMS: The facility has seven (7) restrooms. Six (6) out of six (6) resident bedrooms have an attached restroom and there is one (1) common restroom in the hallway for staff and visitor use. 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 109.2-114.1 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. Smoke detector(s) and carbon monoxide detector were tested at 11:58AM 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. LPA observed a locked laundry area in the hallway containing locked and inaccessible cleaning supplies, disinfectants, and detergents. All auditory exit devices were functional. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for resident use. There is a side gate for resident use and is single-latched. No bodies of water noted. RECORD REVIEW: Beginning at 12:05PM, LPA reviewed five (5) out of five (5) resident files and three (3) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, and staff training. All resident and personnel files were in order. MEDICATION REVIEW: At 01:05PM, LPA reviewed medications for two (2) residents. Medications are centrally stored and locked in a cabinet in the kitchen area. At 01:45PM, LPA observed Resident #1 (R1)’s Levothyroxine 75mg medication with the label stating “Take 1 tablet by mouth daily…5 days per week. Two days per week take half tablet.” However, upon interview and medication review, it was observed that staff administer the medication once daily except for Sundays and not as instructed on the prescription label. Administrator stated that there is no written order from the prescribing physician or the pharmacy; LPA explained that a written order is needed when administration instructions are different from the prescription label. All other medications, including PRNs, 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 09/03/2025. 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, Oct 24, 2025

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Barutyan arrived unannounced to conduct a required annual visit at 10:39AM. LPA met with staff. Licensee Dina Vetchtein and Administrator Doris Almario arrived at 10:49AM and reason for the visit was explained. 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 10:43AM with staff. 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 one (1) staff room, 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. Staff room is kept locked and inaccessible. RESTROOMS: The facility has seven (7) restrooms. Six (6) out of six (6) resident bedrooms have an attached restroom and there is one (1) common restroom in the hallway. The restrooms were clean and sanitary with grab bars and slip-resistant surfaces. Between 10:52AM – 10:59AM, LPA measured hot water temperatures in resident restrooms at 108.1 degrees F – 116.2 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. Smoke detector(s) and carbon monoxide detector were tested at 11:05AM 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. LPA observed a locked laundry area in the hallway containing locked and inaccessible cleaning supplies, disinfectants, and detergents. All auditory exit devices in bedrooms and 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. MEDICATION REVIEW: At 11:08AM, 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 11:32AM, LPA reviewed six (6) out of six (6) resident files and four (4) 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 disaster plan is updated annually as required. Emergency drills are conducted quarterly as is required, with the last drill conducted on 09/09/2024. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 19, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. The LPA met with the Administrator Doris Almario at 12:20 p.m. 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. COMMON SPACES: The common spaces included the living room and dining area. The LPA observed a screened fireplace in the living room. All areas were clean, sanitary and in good repair. Smoke detectors are hardwired and interconnected, all were tested and observed to be operational. The fire extinguisher was observed to be full and last bought on 10/15/2023. The LPA observed required postings on the wall of the living room. At the time of the visit, living room and dining room furniture was observed to be in good condition. The laundry is located in a hallway closet. The seven day supply of water and non-perishable food is located in a closet by the main entrance. KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Knives, medications, and chemicals were locked and inaccessible. BEDROOMS: There are (5) five bedrooms designated for resident use and (2) two bedrooms designated for staff use. The facility has furnished each room with clean linens, appropriate furnishings, and sufficient lighting for resident use. Linen closet was observed to have a sufficient supply of linens and blankets. RESTROOMS: Resident restrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products. Hand-washing signs were identified in all restrooms. Continues on LIC 809... BACKYARD: The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. There is a locked storage shed in the backyard containing supplies and gardening supplies. The passage ways were free of clutter. RECORDS: Records review began at 1:30 p.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 2:00 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 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 - Liabiity Insurance No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 18, 2023