Beverlywood Retirement Home

Type of visit: Required - 1 Year

On 09/24/25, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Staff. The Assistant Irina Fried arrived later. The facility is licensed to serve six (6) non-ambulatory residents aged 60 and over. It also has an approved hospice waiver for two (2) residents. Annual Fees are current. The facility is a single-story structure located in a residential neighborhood. It consists of the following: 6 bedrooms, 3 bathrooms, family room, dining room, kitchen, living room, outside shaded area, indoor and outdoor activity area, laundry room and a detached garage. LPA did not observe any bodies of water on the premises. All walkways around the home were observed to be clean, clear, and free of debris, obstructions, and hazards. Staff accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. The facility is clean, sanitary, and in good repair. Continue to LIC809-C. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew, a non-skid mat was in place, and hot water temperature properly measured at 120 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean, clear of hazards, and doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. Two fire extinguisher, last serviced April 8, 2025 was observed in the kitchen/laundry area and front door exit. LPA tested the carbon monoxide detector and smoke detectors in the house. Both devices were functional. Five (5) staff records were reviewed and 5 out of 5 staff records had current first aid certificates and required criminal record clearances or criminal record exemptions. Five (5) resident records were reviewed, and two (2) residents’ medication was reviewed. Continue to LIC809-C. Deficiencies are being cited according to California Code of Regulations, Title 22. See LIC809-D. During record review, LPA did not observe an annual medical assessment for Resident #1 - #3. An exit interview was conducted, plans of correction developed, technical assistance provided and a copy of this report with appeal rights was discussed and left with Assistant Irina Fried.the state’s words, verbatim · CDSS document, Sep 24, 2025

The state marks this report as 13 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 08/15/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual visit to the facility listed above. LPA met with Care Provider, Genevieve Librando, and the purpose of today’s visit was explained. We were later joined by Licensee/Administrator Sergue Kalistratov and Staff, Irina Fried. The facility is licensed to serve six (6) non-ambulatory residents over the age of 60 with an approved hospice waive for two (2) residents. Physical Plant/Structure The facility is a single-story structure located in a residential neighborhood. It consists of the following: 6 bedrooms, 3 bathrooms, family room, dining room, kitchen, living room, outside shaded area, indoor and outdoor activity area, laundry room and a detached garage. LPA did not observe any bodies of water on the premises. All walkways around the home were observed to be clean, clear, and free of debris, obstructions, and hazards. Bedrooms LPA inspected all resident rooms and observed the walls and floors to be in good repair. LPA observed all resident rooms had the required furniture including a bed, dresser, nightstand, storage space for personal belongings, and ample lighting. LPA observed all beds had the required linens including a mattress cover, fitted sheet, blanket, comforter, and pillows. LPA observed an ample supply of bed linens, and blankets at the time of visit. Beds and bedding were in good condition. Bathrooms LPA inspected the facility bathrooms and found them to be within Title 22 regulations. All bathrooms were observed clean and operational. LPA observed storage area for personal hygiene products. LPA observed an ample supply of towels and personal hygiene products available for residents. All showers had a nonskid mat, shower chair, and secured safety handrails. The water temperature measured 105.4-degrees, 105.2-degrees, and 106.3-degrees Fahrenheit. Kitchen LPA inspected the kitchen and observed it to be clean and sanitary. LPA observed all appliances to be operable and in good repair. LPA observed an ample supply of dishware, cookware, and cutleries. LPA observed a 2-day supply of perishable foods and a 7-day supply of non-perishable foods properly stored and labeled. The water temperature measured 106.7-degrees Fahrenheit. All sharps are secured in a locked drawer and are inaccessible to residents. All cleaning supplies are secured in a locked cabinet in the laundry room and are inaccessible to residents. Common Rooms LPA observed the facility to be appropriately furnished during the time of visit. The facility has a living room with recliners to accommodate all residents. The dining room table is large enough to accommodate residents for meals. LPA observed all walkways and hallways in the facility to be clean, clear, and free of hazards and obstructions. All rooms were observed with ample lighting. The facility was kept at a comfortable temperature. Safety LPA observed two (2) fully charged fire extinguisher located in the laundry room and in the hallway, last serviced on 04/17/24. All smoke and carbon monoxide detectors are operable. The last Fire Prevention Inspection conducted by the local Fire Department was conducted on 04/17/24. The last emergency drill was conducted on 07/01/24. All exits are marked with an EXIT sign. All exits were observed clear of obstructions. LPA reviewed the facility’s Emergency and Disaster Plan. LPA inspected the First Aid kit and observed it had the required items and a current manual. LPA observed all required documents posted in the facility. The facility has a working landline telephone. There are no firearms are ammunition stored at the facility. Medication LPA observed all Centrally Stored Medications secured in a locked cabinet, in the dining room, and are inaccessible to residents. All medications were observed in their original packaging. LPA reviewed the medications and Centrally Stored Medication Logs for three (3) residents, medications are documented properly and provided as prescribed. Infection Control Upon entry, LPA observed a sanitizing station and visitor sign-in log. LPA observed on the table there is hand sanitizer, thermometer, and masks available. LPA observed all required Infection Control signs posted in the facility. LPA observed a 30-day supply of Personal Protective Equipment (PPE). File Review LPA reviewed the files for four (4) residents and observed they had the required documents. LPA reviewed the administrator and two (2) staff files and found they contained the required documents, certification, and training. The administrator’s Administrator Certificate is valid till 08/21/25. LPA received and reviewed a copy of the facility Liability Insurance through Acord valid till, 10/10/24. Licensing fees are current. LPA did not observe or cite any deficiencies. An exit interview was conducted with Staff, Irina Fried, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 15, 2024