1st Class Board and Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nune Margaryan conducted an Annual Required visit and inspection of the facility. LPA met with staff Ivasenko Alexandr. Licensee / Administrator Anna Saakian was contacted over the phone, arrived shortly after and assisted with the visit. LPA explained the purpose of the visit. During the visit, the CARE tool was used. The facility is licensed to serve six (6) non ambulatory residents of which 1 may be bedridden. Hospice waiver is granted for 6 clients. The facility is a single-story home, located in a residential area, that consists of a living room, playroom, dining area, 5 resident bedrooms, 2.5 bathrooms, a kitchen, laundry room, and attached garage. One full bathroom is located inside a resident’s bedroom and another one located in the hallway. The half bathroom is in the laundry room and is designated for staff use. There is a family room, but it is not a part of this facility. LPA toured the facility. All indoor and outdoor passageways were free of obstruction. The front and backyard are well maintained. LPA observed a swimming pool located in the backyard. The pool was secured with a surrounding fence. There is a shaded seating area for the residents located in the backyard. The kitchen was inspected. LPA observed all kitchen equipment to be clean and in working condition. LPA observed sufficient supply of perishable and non-perishable foods. Additional food supplies observed in the garage. Appliances such as a microwave, refrigerator and stove were observed to be clean and operated properly. LPA observed knives unlocked in the kitchen drawer. Cleaning supplies, sprays were observed unlocked under the kitchen sink and accessible to residents. Laundry detergent observed locked in the laundry room. Fire extinguisher was observed in the dining area, and it is fully charged. Carbon monoxide/ smoke detectors were observed in the hallway and resident rooms. Continue 809C The detectors were tested and found to be operable. The common areas are clean and are properly furnished. Resident rooms were sanitary and had the required furniture and furnishings. There is closet space for clothing and other belongings. Extra clean linen was observed in the hallway closets. The resident bathrooms are clean and operational w/grab bars and non-skid surface/mats in place. The hot water temperature was tested in the bathrooms, and reading was showed 115.3-degree F, 116.5-degree F. The first aid kit was observed and found to be in compliance with the Title 22 Regulations. Last fire drill was conducted on 06/05/26. LPA reviewed resident and staff files and observed that all files are updated. LPA confirmed staff working have fingerprint clearances. LPA reviewed resident medications. Medications are documented properly and given as prescribed. Deficiency have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted with Administrator and a copy of this report, LIC 809D and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 15, 2026

Type of visit: Required - 1 Year

On 03/25/2025 at 9:40 AM, Licensing Program Analyst (LPA) Gina Saucedo conducted an unannounced, Annual Inspection and met with Caregiver, Svetlana Vassyyunina. The administrator was called and arrived about fifteen (15) minutes later. LPA asked for the census, staff and resident files. The physical plant was toured inside and out at 10:50 am. Living/Dining Room Area: LPA observed the living room furniture to be clean and in good repair. The facility maintains a comfortable temperature at 74 degrees Fahrenheit with a large television. The living room has a fire place that has a black covering. Bedrooms and Bathrooms: There are five (5) bedrooms. There are two (2) bedrooms that are currently vacant. LPA observed rooms to have bedding sheets, pillowcases, blankets, night stands, televisions, and sufficient lighting for each of the resident’s room. There are three (3) bedrooms that are occupied. One (1) bedroom is shared and has a private bathroom. The other (2) bedrooms are currently privately occupied. There are two (2) other bathrooms. One (1) in the hallway in between the bedrooms and one (1) by the washer and dryer next to the garage. The hot water temperatures in the bathrooms were measured and were within regulations of 116-119 degrees. The showers have non-slip bath mats and grab bars. There is a linen closet in between the bedrooms. Medications: The medication is kept in the kitchen area in a cabinet locked and inaccessible to the residents along with the first aid and centrally stored medication files. There is also a signal system in the facility. The residents are able to ring for assistance if needed. There is one (1) fire extinguisher fully charged and expires on April-2025. It is located in the kitchen. Kitchen Area: LPA inspected the kitchen area. There are two (2) refrigerators which were clean and LPA observed sufficient supply of seven (7) day non-perishable and perishable foods in the cabinets. The knives/sharps are kept in the kitchen area on your left-hand side, inaccessible to the residents. The chemicals are located where the washer and dryer are kept and is locked and inaccessible to the residents. There are several phones located throughout the house. Outside: LPA toured the outside area. LPA observed a covered shaded area for residents and appropriate outdoor furniture. The facility has a pool which is fenced and locked inaccessible to the residents. There is a family room attached to the house which is on the fire clearance and is only be used for staff not residents. There is a garage that can be accessed from the entrance of the facility from the kitchen area. There are supplies in the garage area. The carbon monoxide and the smoke detector were tested, and they were operable, interconnected. Administration: The Liability Insurance was reviewed and will be renewed on 06/2025. The facility has an Emergency and Disaster Plan For Residential Care Facilities For The Elderly and Infection plan. These signs are located in the back of the facility: Personal Rights of Residents, Rights of Resident Council, Family Council, Infection Control, Emergency and Disaster Plan, Theft and Loss Policy, the facility sketch is located throughout the house. The YES sign and Ombudsman sign are located at the entrance of the facility. An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Mar 25, 2025

Type of visit: Prelicensing

On 04/29/24, at 9:35am, Licensing Program Analyst (LPA), Gina Saucedo, conducted an announced visit to the facility for purpose of a pre-licensing evaluation. An application was submitted to Community Care Licensing Division-CCLD on 10/2023, Initial license for a Residential Care Facility for the Elderly, 60 years and older. The requested capacity is for five (5) non-ambulatory and one (1) bedridden, total of up to six (6) residents. There is a side room outside which is considered a family room and it has a full bathroom. Facility is a single-story home. Today's site visit consisted of LPA touring the physical plant at 9:50 AM inside and outside and observed the following: Bedrooms Staff: The side, family room is designated for staff ONLY no residents are to be in this area and/or room. Bedrooms Residents: There is a total of five (5) bedrooms. There shall be no more than two clients per bedroom if used for non-ambulatory. Only one (1) bedroom is cleared for bedridden which is bedroom # 5 (five). Bedroom #5 (five) has a private full bathroom. There is another full bathroom in between rooms two (2) and three (3). There is another half bathroom by the washer and dryer area. The bathrooms have proper grab bars and non-skid mats. All the bedrooms have proper bedding, chairs, nightstands, lamps in addition to overhead lighting. LIC 809C-continued The dining/living room: There is enough seating for staff and residents. The furniture is in good condition. Garage: There is a garage that has another refrigerator. There is access to the garage from the washer and dryer area which is locked and inaccessible to the residents. The washer and dryer area has a half bathroom. The washer and dryer area can be accessed from the kitchen area with a key. Linens & Hygiene Supplies: Adequate supply of linen (bedding/linen) stored in three (3) cabinets by the hallway near bedrooms two (2) and four (4). Emergency Phone Numbers, Exit Plan: The facility has a working phone number land line on the kitchen counter. Fire Extinguisher located in the kitchen on your left-hand side mounted on the wall. It is fully charged and has a date of 10/23. Kitchen/Food Service: Dishes, cups, and flat ware are stored in the kitchen cupboards, inspected and in good repair. Sharps are stored on your left-side of the kitchen locked and secured inaccessible to the residents. The chemicals will be stored under the sink locked and inaccessible to the residents. Food supply adequate stored in several cabinets and consists of the following: canned goods, bottles of water, cereal, emergency buckets. The refrigerator and stove are in good condition and working. The medication cabinet is locked and inaccessible to the residents on your left-side of the kitchen. The first aid kit is next to the medication cabinet. 809C-continued Smoke Detectors: There are smoke detectors/carbon monoxide through-out the house that were tested and work properly. They are hardwired and interconnected with the doors for an emergency. Water Temperature: The water temperature was tested for the bathrooms are they are within regulation:116.-118 Fahrenheit. Pool/Jacuzzi: There is a pool in the backyard which is wired, fenced and locked inaccessible to the residents. Fire clearance: Fire Clearance was approved on 03/08/2024 signed and dated. Signal system: The facility does have a signal system installed. Administration: The facility had submitted a Emergency and Disaster Plan For Residential Care Facilities For The Elderly and Infection plan. These signs are located at the entrance of the facility: Personal Rights of Residents, Rights of Resident Council, Family Council, Infection Control, Emergency and Disaster Plan, Theft and Loss Policy, YES, the facility sketch is located throughout the house. The Component III Orientation was shown to the Administrator. Structure: Overall Facility is a five (5) bedroom home with two (2) and a half bathroom, single-story home with an outside ramp. There is a family room attached to the house which has the fire clearance and will only be used for staff. There is a garage attached to the house. The home does not have a fireplace which is covered in the dining area. There is one (1) washer and dryer located next to the kitchen which is locked and inaccessible to the residents. The house also has a pool.the state’s words, verbatim · CDSS document, Apr 29, 2024