Balboa Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Rebekah Ramirez, and explained the reason for the visit. The administrator could not be present for the annual, but the licensee/owner, Vladislav Blitshteyn. At approximately 9:25am, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide are dual and interconnected. There are two fire extinguishers. One is located in the kitchen, and the other is located at the hallway by resident room #6. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food properly stored. Knives were stored in a locked drawer in the kitchen. LPA did no observe any cleaning supplies out and accessible in the kitchen. Bedrooms: There are seven (7) bedrooms. Six (6) of the bedrooms designated for residents' use are private. One (1) room is designated for staff. The bedrooms designated for the residents use were observed to be properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are three (3) bathrooms designated for the residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured between 111 and 112 degrees Fahrenheit. No cleaning supplies were observed in either bathrooms during the day of the inspection. Common Areas: These included the living room and dining area. The living room has sufficient seating of a large couch and a television. The dining room, located adjacent to the living room has a table large enough to seat up to six (6) residents. Living room and dining room furniture are observed to be in good repair. Floors were mopped and clean. Exits and passageways were clear of any obstruction. Surrounding Grounds: The front and back yards were free of obstruction. There was furniture in the backyard appropriate for outdoor use. There is sufficient yard space in the backyard to hold outdoor activities. There is no swimming pool or any other bodies of water. Exterior gates are only locked from the outside of the property. It is unlocked from the inside making it accessible for exit. Laundry area: The laundry area is by the kitchen. Detergents and cleaning agents were locked. Staff Workstation/Office: There is a staff workstation by the kitchen where resident and staff records are kept in a filing cabinet. Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medications are stored locked in a kitchen cabinet. Medication and Medication Records were reviewed for proper storage and documentation. Garage: The garage is attached to the building. Entry is from either outside from the backyard, or internally, by room #6. Garage is used to store supplies. It was locked during the annual. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Jan 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Rusanna Sargsyan, and explained the reason for the visit. The administrator, Mario Ochoa, joined shortly after. At approximately 9:00am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide are dual and interconnected. There are two fire extinguishers. One is located in the kitchen, and the other is located at the hallway by resident room #6. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. LPA did no observe any cleaning supplies out and accessible in the kitchen. Bedrooms: There are seven (7) bedrooms. Six (6) of the bedrooms designated for residents' use are private. One (1) room is designated for staff. The bedrooms designated for the residents use were observed to be properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are three (3) bathrooms designated for the residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured between 109 and 114 degrees Fahrenheit. No cleaning supplies were observed in either bathrooms during the day of the inspection. Common Areas: These included the living room and dining area. The living room was furnished with two couches, a recliner and a television. The dining room, located adjacent to the living room has a table large enough to seat up to six (6) residents. Living room and dining room furniture ere in good repair. Floors were mopped and clean. Exits and passageways were clear of any obstruction. Surrounding Grounds: The front and back yards were free of obstruction. There was furniture in the backyard appropriate for outdoor use. There is sufficient yard space in the backyard to hold outdoor activities. There is no swimming pool or any other bodies of water. There is a storage that is observed to be locked. Exterior gates are only locked from the outside of the property. It is unlocked from the inside making it accessible for exit. Laundry area: The laundry area is by the kitchen. Detergents and cleaning agents were locked. Staff Workstation/Office: There is a staff workstation by the kitchen where resident and staff records are kept in a filing cabinet. Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medications are stored locked in a kitchen cabinet. Medication and Medication Records were reviewed for proper storage and documentation. Garage: The garage is attached to the building. Entry is from either outside from the backyard, or internally, by room #6. Garage is used to store supplies. It was locked during the annual. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Nov 14, 2024

Allegation investigated: Staff are not able to meet resident's needs due to inadequate staffing.

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. It was reported that Resident 1 (R1), who stayed at the facility on or about 01/23/24 until on or about 01/25/24, and or their family was unable to communicate with staff, therefore unable to meet R1's needs due to a language barrier. LPA met with staff, Rosanna Sargsyan and advised her of the complaint. The administrator, Armine Eritisian was notified shortly after. Today's investigation consisted of interviews with the administrator and staff, and a physical plant inspection. Interviews with the administrator confirm that R1 stayed at the facility for approximately three days. R1's family found another facility suitable for their needs. It was also revealed that Staff 1's (S1) English was limitied, making it challenging for staff to communicate with a resident and their responsible party. S1 no longer works at the facility. Based on the information obtained, the allegation of staff unable needs to to inadequate staffing is Substantiated. Citation issued on the 9099D. Substantiatedthe state’s words, verbatim · CDSS document, Feb 14, 2024 · control 31-AS-20240207114039

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Feb 21, 2024

Personnel Requirements - General: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by confirmation during investigation on 02/14/24. It was revealed that Staff 1's (S1) English was limited, making it challenging for staff to communicate with a resident and their family.the state’s words, verbatim · CDSS document, Feb 14, 2024

Plan of correction: S1 no longer works at the facility. Moving forward, the licensee will insure that all staff hired will be sufficient in numbers and competetent enough to communicate with the resident and their families. As POC, the administrator will read this section of the regulation, and self certify, that they have read and undeerstood this section of the regulations. Self certification is due to the licensing agency by 02/21/24.

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Leslie Ngo-Castaneda, Gina Saucedo and Huma Rahimi conducted an announced pre-licensing visit at 10:00 AM and met with the licensee Vladsilav Blitshteyn and administrator Luiza Yengibaryan. In addition to the pre-Licensing inspection, a component III power point presentation was also held. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on August 1, 2023. LPAs observed that no residents during the inspection. A tour of the physical plant was initiated at approximately 11:25am and the following was observed: With the assistance of the licensee and administrator, LPAs conducted a facility tour of both the inside and outside. This is a single-story property. The facility is a one-story building with seven (7) bedrooms and three (3) bathrooms. A fire clearance was approved on September 13, 2023, for six (6) non-ambulatory. One (1) can be used as ambulatory and one (1) bedridden for a total capacity of six (6) residents. The applicant is also requesting a hospice waiver to retain five (5) residents. All residents’ bedrooms were adequately furnished. The facility has a designated a live-in staff restroom and staff bedroom. Resident bathrooms have properly installed grab bars and shower has non-skid flooring. Hot water temperature for bathroom # 1 between room # 4 and 5 measured at 118.1ºF, and bathroom # 2 between room # 2 and #3 measured at 114.4 ºF during the visit. The facility has an adequate temperate of 73 ºF and 75 ºF. The common areas were appropriately furnished these included the living and dining room area. The living room was equipped with couch, non-audible camera, a television, tables and chairs. The LPAs observed entertainment equipment and games for activities. The facility has a kitchen area that is equipped with a non-audible camera, refrigerator, microwave oven, and sink. The dining table is large enough to seat six (6) individuals. Continue to LIC 809-C The facility has a staff workstation that is in the kitchen where designated storage cabinet for residents and staff records are located in a lock cabinet. The first-aid kit is complete. The facility has adequate linen, water, and emergency kits. The linens were stored in the storage space located in the hallway. LPAs observed a fireplace that is turned into an aquarium. The smoke alarms and carbon monoxide detector are dual and inter-connected. There is a fully charged fire extinguisher located in the kitchen area and both hallways. The hallways are well lighted and a night-light. Receipt shows that fire extinguisher was purchased on 11/01/2023 and LPAs advised the licensee to retain the receipt of the fire extinguisher identifying the purchase date to ensure the time frame for annual inspection. There are six (6) bedrooms designated for resident use. All six rooms are designated for private use. Currently, room #3 is used as the model bedroom. Room #3 was equipped with bed, night-stand chair, dresser, bedding, bedbug covers and linen. Rooms #1, #2, #4, #5 and #6 were not completely furnished without a bed only at this time. Rooms were observed to have sufficient lighting and closet space. Per STD 850, Bedroom #1, #2, #4, #5 and #6 is ambulatory only. Bedrooms #3 is cleared for non-ambulatory for one bedridden only. LPAs observed a washer and dryer in the laundry room within the kitchen with a closed and lock door. All chemicals, additional personal hygiene items were stored and locked in the laundry room. The medications are stored in a locked cabinet located in the kitchen. LPAs inspected the kitchen and observed gas stove and refrigerator to be clean and working. Knives and sharps are stored in a locked kitchen drawer. The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. There is sufficient outdoor space with seating and a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised, and a copy of this report provided. No health and safety hazard were noted during this visit. Licensee shall contact LPA once the first resident is admitted. Exit interview was conducted and a copy of report was issued.the state’s words, verbatim · CDSS document, Nov 7, 2023

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Name - Vladislav Blitshteyn CEO/ Luiza Yengibaryan Administrator Interview Method: Telephone interview On October 10, 2023, 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 the 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 10, 2023