Gem Oaks

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 12:55 p.m. Upon arrival, LPA Mosley was greeted by staff and The Administrator / Licensee Representative, Elmira (Emma) Sabyrova and the reason for the visit was explained. Entrance interview. The LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: This includes the living room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 1:16 p.m., hardwire combination of smoke / carbon monoxide detectors and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 07/09/2026. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. Activities were observed in the common areas. The fireplace in the living room was adequately screened. There is a functioning telephone on the premises. LPA observed surveillance cameras installed in the common areas of the facility. The Administrator presented the live monitoring screen to the LPA, confirming that all cameras were functioning properly and that none of them were equipped with audio capability. GARAGE: LPA observed the locked garage adjacent to the entrance. Garage contains a washer and dryer and locked cleaning supplies. LPA observed emergency food and water. LPA observed two (2) refrigerators that were checked for proper labels and expiration dates. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... BEDROOMS: There are seven (7) total bedrooms in the facility; Six (6) bedrooms are designated as private, single occupancy, resident rooms and one (1) staff room. The staff room is kept locked at all times and observed to be occupied by staff. Two (2) out of six (6) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are four (4) total restrooms. One (1) is designated as a shared / common resident restroom, Two (2) are designated as private resident restrooms, One (1) is designated as guest / staff restroom. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 112.3-119.9 degrees Fahrenheit, all within the required range. LPA observed storage space closets in hallway containing extra clean linens and towels for resident use. KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 113.2 degrees Fahrenheit. Cleaning supplies and other chemicals are kept locked under the sink and inaccessible to residents in care. BACKYARD: The entire property is fenced. The backyard has a covered patio area with shade, patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed two (2) self-latching gates. There were no bodies of water noted at the time of the visit. There are two (2) locked storage sheds in the back yard inaccessible to residents. Only one (1) pathway is used as an emergency exit which was free of obstructions at the time of the visit. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... MEDICATIONS: Medication review began at approximately 1:47 p.m. Medications are centrally stored and locked in two (2) cabinets above the desk in kitchen adjacent to the entrance. Medications for five (5) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. RECORDS: Resident Records Three (3) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, Home health records, PRN authorization letters, and current needs and services plan. All records were in order. Personnel Records Four (4) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated (10/30/2025 and 12/30/2025) annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. The last emergency disaster drill took place on 08/28/2026 and are conducted quarterly. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster and LIC 9020A Resident roster and copy of the Limited Liability insurance. At the time if the visit the LPA reviewed the facilities contact information on file including phone numbers, email and annual fees. Administrator confirmed that all information is accurate. No citations issued. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, Sep 25, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:55 a.m. Upon arrival, LPA Mosley was greeted by staff and Facility Designee Ernis Sabyrov who called the Administrator to inform them of the visit and the reason for the visit was explained. The Administrator / Licensee Representative, Elmira (Emma) Sabyrova arrived during the visit. Entrance interview. The LPA and Facility Designee Ernis Sabyrov toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: This includes the living room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 10:10 a.m., hardwire combination of smoke / carbon monoxide detectors and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 07/14/2025. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 07/11/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. There is a functioning telephone on the premises. LPA observed surveillance cameras installed in the common areas of the facility. The Administrator presented the live monitoring screen to the LPA, confirming that all cameras were functioning properly and that none of them were equipped with audio capability. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... GARAGE: LPA observed the locked garage adjacent to the entrance. Garage contains a washer and dryer and locked cleaning supplies. LPA observed emergency food and water. LPA observed two (2) refrigerators that were checked for proper labels and expiration dates. BEDROOMS: There are seven (7) total bedrooms in the facility; Six (6) bedrooms are designated as private, single occupancy, resident rooms and one (1) staff room. The staff room is kept locked at all times and observed to be occupied by staff. Two (2) out of six (6) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are four (4) total restrooms. One (1) is designated as a shared / common resident restroom, Two (2) are designated as private resident restrooms, One (1) is designated as guest / staff restroom. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 105.6-116.1 degrees Fahrenheit, all within the required range. LPA observed storage space closets in hallway containing extra clean linens and towels for resident use. KITCHEN: The LPA inspected the kitchen/food service area at 10:22 a.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 118.6 degrees Fahrenheit at 10:25 a.m. Cleaning supplies and other chemicals are kept locked under the sink and inaccessible to residents in care. BACKYARD: The entire property is fenced. The backyard has a covered patio area with shade, patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed two (2) self-latching gates. There were no bodies of water noted at the time of the visit. There are two (2) locked storage sheds in the back yard inaccessible to residents. Only 1 (one) pathway is used as an emergency exit which was free of obstructions at the time of the visit. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... RECORDS: Resident Records were reviewed beginning at 10:26 a.m. Six (6) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, Home health records, PRN authorization letters, and current needs and services plan. All records were in order. Personnel Records were reviewed beginning at 11:09 a.m. Five (5) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning, are satisfactory. INTERVIEWS: Starting at 12:00 p.m. Three (3) staff and two (2) resident interviews were conducted. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interview revealed that no concerns were noted or voiced at the time of the visit. MEDICATIONS: Medication review began at approximately 12:30 p.m. Medications are centrally stored and locked in two (2) cabinets above the desk in kitchen adjacent to the entrance. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster and LIC 9020A Resident roster and copy of the Limited Liability insurance. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, Sep 12, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 11:27AM. The LPA was greeted by staff and explained the reason for the visit. Facilty Designee Ernis Sabyrov arrived shortly thereafter. Administrator Elmira (Emma) Sabyrova arrived at approximately 01:00PM. Beginning at 11:52AM, the LPA and Facility Designee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguisher was observed to be fully charged and purchased on 09/13/2023. Hardwired combination smoke and carbon monoxide detectors were tested at 02:30PM and were operational at the time of the visit. KITCHEN: Knives and sharps were observed in a locked drawer next to the stove. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food and a locked refrigerated medication box. COMMON AREAS: Living and dining room furniture were observed to be in good condition. The LPA observed required postings throughout the common space. The garage is attached to the facility and is locked and inaccessible. Garage contains laundry facilities, extra food, cleaning supplies and emergency food and water. RESTROOMS: The resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature was measured in a sample of bathrooms and was within the required range. BEDROOMS: There are 6 (six) private resident bedrooms, which were furnished with appropriate linens and Report Continued on LIC 809-C Continued from LIC 809 required furniture. Adequate lighting in all bedrooms was observed. There is 1 (one) staff room which was locked. OUTDOOR SPACE: There are 3 sheds in backyard that are used for storage. All hazardous items were observed locked. The backyard has a covered outdoor area equipped with furniture for resident use. The LPA observed two side gates that are self-closing and latching. Passageways were observed clear of obstructions in case of an emergency. No bodies of water noted at the time of visit. RECORD REVIEW: Record review began at 12:20PM. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. 1 (one) resident (Resident #1 - R1) with a diagnosis of dementia had a medical assessment dated 04/17/2023 and a needs and service appraisal dated 04/21/2023. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All staff files were in order. MEDICATIONS: Medications review began at 02:55PM; 2 (two) residents' medications were observed. Medications are centrally stored and locked in a mediation cabinet in the kitchen. Medications are documented on the centrally stored medications and destruction record. LPA observed that both residents had medications that had recent changes in orders. Based on the change in orders and days elapsed since the changes, both residents medication counts did not match the amount that should have been distributed. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 05/22/2024. INTERVIEWS: During the visit, LPA interviewed 3 (three) staff and 1 (one) resident. No concerns noted. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 10, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.