Serenity Villa II

Type of visit: Office

An informal meeting was conducted today in the Santa Rosa Regional Office. Present at the meeting were Licensing Program Manager Victoria Bertozzi, Licensing Program Analyst Christi Coppo, and licensees of the facility, German Sinitsyn and Aida Reznik. The purpose of the office meeting was to address the use of gait belts in the facility. On 10/15/25, LPA Coppo conducted the facility's annual inspection and observed three residents in wheelchairs with gait belts being used as a restraint. The belts were fastened and threaded such that the residents could not release themselves from the restraint. Areas discussed and addressed with licensees during this office meeting were: the proper use of gait belts: regulation 87608(a)(4) personal rights of residents and staffing ratios: regulation 87468.2(a)(4) the use of activities as redirection for residents' wandering or sundowning behavior Exit interview conducted and a copy of this report was given.the state’s words, verbatim · CDSS document, Nov 5, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Licensee German Sinitsyn arrived later. Facility currently has twelve (12) residents in care none of which are currently on hospice. Aida Reznik Administrator Certificate 7010118740 expires 4/11/27. All fees are current as of this time. Upon arrival, LPA observed residents restrained in wheelchairs. LPA obtained photographic and video evidence of restraints. LPA observed resident (R1) in wheelchair with gait belt being used as restraint. Gait belt was fastened and threaded with belt release placed behind resident in back of wheelchair, inaccessible to resident to release. LPA observed resident (R2) in wheelchair with fabric belt wrapped around their chest area and tied in a knot behind their wheelchair, inaccessible to resident to release. LPA observed resident (R3) in wheelchair with velcro fabric belt wrapped twice around their chest area and back of wheelchair, secured by velcro and the end of the belt tucked into the back right hand side their wheelchair, inaccessible to resident to release (deficiencies cited, see 809D). At approximately 10:30am LPA toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered and labeled with opened dates present. LPA observed kitchen cabinet under sink to contain disinfectants and cleaning supplies. Cabinet has magnetic locking mechanism, but lock was malfunctioning at the time of inspection, it was sticking such that when the door closed the lock did not latch. LPA showed malfunction to licensee, Continued on 809C... Continued from 809... licensee got the lock to function properly but licensee will purchase new lock and replace. All other cleaning products and laundry soaps were found inaccessible to residents in care. All bedrooms were equipped with lighting, night stand, and chest of drawers. Lamp in room #8 functions but light bulb wiring loose and could present as a hazard. LPA showed licensee potential hazard; licensee discarded lamp and will replace. All bedrooms were clean and in good repair. However, LPA noticed strong smell of feces in closet of room #7. LPA found source of feces smell in drawer of night stand located in the closet. Bottom drawer had a pile of feces approximately 3 inches high and 6 inches long, covering the entire back right hand corner of the drawer. Pile of feces had some areas of crusting (deficiency cited, see 809D). Extra hygiene products and linens were available. Resident bathrooms had required bath mats and grab bars. Water temperature in sinks measured at 111.4 degrees F in the kitchen, 113.7 degrees F in the bathroom of room #2, and 112.4 in the bathroom of room #3, all of which are within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 1/15/25. Smoke/Carbon Monoxide detectors located throughout the facility were operational. Facility has hardwired fire alarm which is serviced by vendor, last date of service was June 2025 per sticker on box. Facility’s last quarterly disaster drill was conducted on 9/2/25. Facility has a backup generator for use during a power outage. At approximately 12:00pm LPA conducted a review of six (6) out of twelve (12) resident files. No deficiencies cited. At approximately 1:45pm LPA conducted a review of six (6) of eight (8) staff records. No deficiencies cited. At approximately 2:30pm LPA and Licensee conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet located in the kitchen. LPA discussed with licensee ensuring that all discontinued medication orders are maintained on file. No deficiencies cited. Continued on 809C(2)... Continued form 809C... Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Oct 15, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a Case Management and was greeted by caregiver. Administrator Aida Reznik reached by phone. On 7/3/25 fire clearance was granted for facility capacity change from 12 to 15. LPA toured rooms identified in capacity change. Room number 2 was converted into two rooms, now identified as room #2A and room #2B. Based on LPA observation, rooms appear to meet requirements in regulation 87307(a)(2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: · (A)Bedrooms shall be large enough to allow for easy passage between and comfortable usage of beds and other required items of furniture specified below, and any resident assistant devices such as wheelchairs or walkers. · (B)No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage storage area, shed or similar detached building. · (C)No bedroom of a resident shall be used as a passageway to another room, bath or toilet. · (D)Not more than two residents shall sleep in a bedroom. Exit interview conducted with Administrator via telephone and a copy of this report was given to caregiver. No deficiencies cited.the state’s words, verbatim · CDSS document, Jul 23, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Licensee arrived later. At approximately 9:30am LPA toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathroom had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 112.3 degrees F in the kitchen and 108.1 degrees F in room #5 which are both within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 12/21/2023. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drills were conducted 6/10/2024. LPA advised licensee to be sure to conduct fire drills every quarter. Facility has a backup generator for use during a power outage. At approximately 11:00am LPA conducted a review of 6 resident records. All required documentation present. At approximately 11:30am LPA conducted review of 5 staff records. LPA discussed modifying training record to include date completed and training certificates to include number of hours completed. All required documentation present. Continued on 809... Continued from 809... At approximately 12:00pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies. Aida Reznik Administrator Certificate 7010118740 expires 4/11/2025. All fees are current as of this time. No deficiencies cited.the state’s words, verbatim · CDSS document, Oct 29, 2024

The state marks this report as 6 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff verbally abusing resident

At approximately 1:00pm, Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to deliver findings regarding the above allegations and met with caregiver. Aida Reznik, Administrator contacted by phone and gave permission for caregiver to sign. Complaint alleges staff verbally abusing resident. Three [3] out of five [5] interviews with residents indicate that they have never been yelled at by a staff member; one (1) resident reported that they heard yelling, but it was more like talking loudly. Resident reports that no one has ever yelled at them. One (1) resident reported that they were yelled at, but that staff member no longer works here. The involved staff denies yelling. LPA did not observe any yelling by staff. However, LPA interviewed 3 out of 7 staff and each staff stated they have heard staff yell at residents. Based on LPA's observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8, are being cited on the attached LIC 9099D. Substantiated Continued from 9099A... Complaint alleges facility is not meeting resident's care needs. Per review of records, resident was admitted to facility 2/20/2024 during a transitional time regarding their healthcare team. There were multiple changes in the persons providing care or assigned to the resident’s healthcare team. Resident is pre-diabetic and requires a consistent controlled carbohydrate (CCHO) and mechanically soft diet. Resident is non-ambulatory and requires assistance with ADLs, with the exception the resident is able to feed themselves. Per record review, facility has monitored blood sugar of resident beginning the day after admittance. Interviews with staff indicate an initial lack of clarity by resident’s healthcare team in regards to what actions need be taken if the blood sugar is too high or too low. Licensee requested clarification from resident’s healthcare nurse and received instruction as of 3/23/2024. On 3/27/2024 licensee held training with staff and made a chart for them specific to resident, as to an action plan regarding blood sugar readings. Record review shows that the resident was to receive a shower or sponge bath on Tuesdays, and a shower on Fridays. Record review shows that resident refused showers on a regular basis. Resident is not ambulatory and works with physical therapy to regain ambulatory status. Per interviews with staff and outside party, resident is often resistant to physical therapist’s suggestions for activity. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.the state’s words, verbatim · CDSS document, Jun 28, 2024 · control 21-AS-20240410150612

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Jul 1, 2024

Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on LPA interviews, the licensee did not comply with the section cited above in that facility staff was observed to have yelled at residents, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 28, 2024

Plan of correction: Facility has terminated staff found to have yelled at residents. Deficiency cleared.

Type of visit: Collateral

Licensing Program Analyst (LPA) Cuadra arrived to conduct collateral visit to interview with residents in care regarding complaints unrelated to this facility and met with Oralia Vera, facility staff. No deficiencies cited during today's inspection.the state’s words, verbatim · CDSS document, Mar 21, 2024