Pacific Breeze Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Irina Maroussenko and explained the reason for the visit. The facility is a 6 bedroom house (1 bedroom is for staff) with 2 bathrooms, kitchen, dining room, living room and an attached 3 car garage. The facility is licensed for 6 non-ambulatory residents with a hospice waiver for 4. Irina Maroussenko Administrator's Certificate expires on June 14, 2028. LPA and Administrator toured the facility. LPA observed the PUB 475 poster posted in the entry way of the facility. The garage is kept locked and used for storage. Smoke detectors and the carbon dioxide detector tested operational. The fire extinguisher mounted in the dining room is fully charged. The last emergency drill was conducted on June 10, 2025. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed a 3 day supply of emergency food and water stored in the kitchen. LPA observed knives are kept locked in a box on the kitchen counter. The 5 burner gas stove lights unassisted. LPA observed the fireplace in the living room is screened. LPA and the Administrator toured the resident bedrooms. All resident bedrooms were clean and organized. All the resident bedrooms had the required furniture and bed linens. LPA observed all residents had half or quarter bed rails. All 5 residents had the proper doctor's order for bed rails. LPA observed both bathrooms are clean and operational. Hot water measured 116.2 degrees Fahrenheit in both bathrooms. LPA observed medication is kept locked in a medication cart kept in the staff bedroom. LPA and the Administrator toured the backyard. No bodies of water observed. There is a covered patio with chairs for residents to sit outside. The exit gate is operational. No obstacles or hazards observed in the backyard. LPA reviewed 5 resident files and medications. No discrepancies observed. LPA reviewed 3 staff files, no discrepancies observed. All 3 staff members had the required 20 hours of annual training. All 3 staff members had current CPR training. All 3 staff members are background cleared and associated to the facility. LPA observed the facility has an internet device for resident use only. LPA verified the device is operational. LPA interviewed staff and residents. No obstacles or hazards observed inside the facility. LPA observed the first aid kit had all the required elements. No deficiencies observed during the visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted with the Administrator and a copy of the report provided.the state’s words, verbatim · CDSS document, Jul 10, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Irina Maroussenko and explained the reason for the visit. The facility is a 6 bedroom house (1 bedroom is for staff) with 2 bathrooms, kitchen, dining room, living room and an attached 3 car garage. The facility is licensed for 6 non-ambulatory residents with a hospice waiver for 4. Irina Maroussenko Administrator's Certificate expires on June 14, 2026. LPA and Administrator toured the facility. LPA observed the PUB 475 poster posted in the entry way of the facility. The garage is kept locked and used for storage. Smoke detectors and the carbon dioxide detector tested operational. The fire extinguisher mounted in the dining room is fully charged. The last emergency drill was conducted on July 10, 2025. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed knives are kept locked in a box on the kitchen counter. LPA observed the fireplace in the living room is screened. LPA and the Administrator toured the resident bedrooms. All resident bedrooms were clean and organized. All the resident bedrooms had the required furniture and bed linens. LPA observed both bathrooms are clean and operational. Hot water measured 120.0 degrees Fahrenheit in both bathrooms. LPA observed medication is kept locked in a medication cart kept in the staff bedroom. LPA and the Administrator toured the backyard. No bodies of water observed. There is a covered patio with chairs for residents to sit outside. The exit gate is operational. No obstacles or hazards observed in the backyard. LPA reviewed 4 resident files and medications. No discrepancies observed. LPA reviewed 2 staff files, no discrepancies observed. Both staff members had the required 20 hours of annual training. Both staff members had current CPR training. Both staff members are background cleared and associated to the facility. LPA observed the facility has an internet device for resident use only. LPA interviewed staff and residents. No obstacles or hazards observed inside the facility. LPA observed the first aid kit had all the required elements. An exit interview was conducted with the Administrator and a copy of the report provided.the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Irina Maroussenko and explained the reason for the visit. The facility is a six bedrooms (1 is for staff) house with 2 bathrooms, kitchen, dining room, living room and an attached two car garage. LPA and the Administrator toured the facility. LPA observed the PUB 475 poster posted in the entry way of the facility. The garage is kept locked and used for storage. Smoke detectors and the carbon dioxide detector tested operational. The fire extinguisher mounted in the dining room is fully charged. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed knives are kept locked in a box on the kitchen counter. LPA observed the fireplace in the living room is screened. LPA and the Administrator toured the resident bedrooms. All resident bedrooms were clean and organized. All the resident bedrooms had the required furniture and bed linens. LPA observed both bathrooms are clean and operational. Hot water measured 106.1 degrees Fahrenheit in both bathrooms. LPA observed medication is kept locked in a medication cart kept in the staff bedroom. LPA and the Administrator toured the backyard. No bodies of water observed. There is a covered patio with chairs for residents to sit outside. The exit gate is operational. No obstacles or hazards observed in the backyard. LPA reviewed 5 resident files and medications. No discrepancies observed. LPA reviewed 2 staff files, no discrepancies observed. Both staff members had the required 20 hours of annual training. Both staff members had current CPR training. LPA observed the Administrator did not have a current Administrator's certificate. LPA observed the facility has WiFi but does not have a device for resident use. LPA interviewed staff and residents. No obstacles or hazards observed inside the facility. LPA observed the first aid kit had all the required elements. Deficiencies are being cited per title 22 Division 6 of the California Code of Regulations on the attached LIC 809D. An exit interview was conducted with the Administrator and a copy of the report provided along with appeal rights.the state’s words, verbatim · CDSS document, Jul 2, 2024