Beit Shalom Group II

Type of visit: Required - 1 Year

On November 1, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with House Manger Naome Leibov and explained the purpose of today’s visit. The facility is licensed to operate for six (6) non-ambulatory of which one (1) may be bedridden elderly residents ages 60 and above. The facility is approved for (1) hospice residents. Currently, the facility has no resident in hospice care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: three (3) shared resident's rooms, two (2) common bathrooms, a living area, a dining area, a kitchen, and an outside covered patio are and garage used for storage. LPA and administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 106.2 degree F. A comfortable temperature of 76 degree was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Evaluation Report Continues LIC 809-C Fire extinguisher were charged, smoke detectors and carbon monoxide were operable. A review of the Medication Administration Record (MAR) was complete and accurate. A landline telephone was in working condition. The facility has conducted Fire Drills 09/10/26. LPA observed First Aid Kit was maintained. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters were posted. The facility is current on Community Care Licensing annual dues. An audit of residents #1-#4 (R1-R4) service files and staff #1-#4 (S1-S4) personnel files revealed to be complete. A review of staff CPR/First Aid training is current. The facility has the current administrator's certification on file for Miriam Rudes #700972140 Expiration: 11/12/26. The facility has a current liability insurance policy #001060484-0 valid 12/21/24 through 12/21/25. No deficiencies issued. An exit interview was conducted with Noaome Leibov, and a copy of the report and appeal rights provided. .the state’s words, verbatim · CDSS document, Nov 1, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Miriam Rudes (Managing Member/Administrator) Interview Method: Virtual interview via Microsoft Teams On October 11, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 11, 2024