Four Seasons Home Care

Type of visit: Required - 1 Year

On 01/28/2026, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with care staff Avonett John and explained the purpose of the visit. The Administrator, Doina Savin then arrive approximately 20 minutes later and joined the visit. The Administrator Certificate # is 7002889740 and will expire on 10/20/2027. The current census is 6 with 1 facility staff. This facility is a single story building licensed to serve six (6) non-ambulatory residents with an approved hospice wavier for three (3) residents. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room, garage, and staff office/room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 118.1 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. The smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in entry of the hallway and was last serviced on 12/12/2025. The last fire drill was conducted on 12/01/2025. LPA Lee observed the facility has a has a public telephone in the kitchen and the facility has the required posters posted. Facility thermostat was observed at 75 degrees Fahrenheit, which is within the required regulation of 68 to 85 degrees Fahrenheit. CONTINUED LIC 809-C LPA Lee observed toxins and sharp knives located in the kitchen cabinet and kept them locked and inaccessible to residents. LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. The first aid kit was checked and contained the required components. LPA Lee audited medications for 3 out of 6 residents by comparing the medications on hand with their Medication Administration Records (MARs) and confirmed that all records were accurate and complete. LPA Lee reviewed 6 out of 6 resident files, and they were complete. LPA Lee reviewed 2 staff files, and it was also complete. LPA Lee reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. The following documents were provided to LPA Lee during today’s visit: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with Administrator Savin a copy of these LIC 809 reports was provided to the facility.the state’s words, verbatim · CDSS document, Jan 28, 2026

Type of visit: Required - 1 Year

On 1/9/24, Licensing Program Analyst (LPA) Arvin Villanueva arrived to the facility unannounced to conduct an annual required visit. LPA met with Administrator Doina Savin (ADM) and stated the purpose of the visit. Present during this visit are 6 residents with 2 staff on duty. LPA and ADM toured the facility inside and out to ensure compliance with Title 22 regulations. LPA observed bedrooms, bathrooms, common areas, kitchen area, dinning area, and exterior areas. Facility is a one-story home located in a quiet residential neighborhood. Facility has 5 resident bedrooms. One bedroom is shared. Resident bedrooms were observed to be spacious to accommodate residents' belongings and each bedrooms has an exit to the outside. Two bathrooms were observed and both were equipped with grab bars, commode and slip resistant flooring. Solid waste were properly disposed in close lid garbage cans. Medications, toxins, sharps and other dangerous items were observed to be locked and inaccessible to residents. Carbon monoxide and smoke detectors were observed, tested and found to be operable. Kitchen area was observed to be clean, sanitary and free of clutter. Fire extinguishers with last serviced on 12/4/24 and was observed to be in working condition. The facility temperature was comfortable at 73*degrees. Hot water temperature in two bathrooms were measured between 118 and 119 degrees F. The facility was observed to have an adequate supply of food to meet the requirements of 2 days of perishable foods and 7 days of non-perishables foods. An emergency supply of food was also observed. Outdoor furniture were observed. Fences and gates on both side of the home were observed to be in good repair. Storage shed at the backyard was observed to be locked. Two window screens were observed to have rip. Advisory was provided to have these window screens to be repaired. LPA conducted record review of 4 staff files which include, but not limited to, review of 1st Aid/CPR, background clearance, and health screen. No issues were noted at this time. {1 of 2} LPA conducted 4 resident files which include, but not limited to. review of medical assessments, needs and services plan, centrally stored medication records, and ambulatory status. Medication review of 2 of 6 residents was conducted and found to be in compliance at this time. LPA also reviewed facility's infection control plan and found to be reviewed annually by the administrator. Facility also conducts quarterly disaster drill. Last drill was conducted on 12/5/24. LPA reviewed first aid kit and found to be in compliance at this time. LPA requested copy of the following documentation: LIC 500, LIC 308, LIC 610E, current Liability Insurance Per California Code of Regulations (CCR), Title 22, no deficiencies were observed during today's visit. An exit interview was held, and a copy of the report was provided. {2 of 2}the state’s words, verbatim · CDSS document, Jan 9, 2025

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 1/4/24 at 10:30am. LPA observed the Administrator Certificate is on the pending list with Department of Social Services (CCL) and has not been received yet. LPA met with Doina Savin, Administrator and stated the purpose of todays visit. The facility is licensed for a capacity of 6 non-ambulatory residents of which 3 may receive hospice care services. There is 2 residents receiving hospice care services during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables. The most current disaster drill was conducted on 12/15/23. The temperature inside the facility was observed to be at 74*F which is within the required range of 68-85*F. The hot water temperature was measured at 110.5*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA reviewed 2 staff and 2 resident files and conducted interviews during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Licensing fees-Current Criminal Record Clearances LIS536-Current Administrative Organization LIC309-Current Designation of Administrative Responsibility LIC308-Submit Personnel Report LIC500-Submit Affidavit Regarding Client/Resident Cash Resources LIC400-NA Surety Bond LIC402-NA Facility Floor Plan/Plot Plan LIC999-Current Fire Clearance (consistent with terms and limitations of license)-NA Qualifications of Administrator/Facility Manager-Submit Articles of Incorporation/Organization, Constitution and bylaws-NA Partnership Agreement-NA Control of Property-Current Emergency Disaster Plan LIC610-Submit Plan of Operation (Restricted Health Care Plan)-NA Admission Policies and Procedures-NA Health Screening Report-Facility Personnel LIC503-NA Bacteriological Analysis of Private Water Supply-NA In-service Training Program-NA Medication Procedures-NA Transportation Procedures-NA Job Description/Personnel Policies-NA Exemptions/Waivers and Exceptions-Current First aid/CPR certificates-Submit Liability Insurance-Submit Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. Exit interview held. A copy of todays’ report provided.the state’s words, verbatim · CDSS document, Jan 4, 2024