Baltic Sea Manor

Type of visit: Required - 1 Year

On 3/18/2026 at 3:30pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with Caregiver, Gloria Martinez de Godsen, and explained the purpose of the visit. LPA spoke with Administrator, Vivian Price, via telephone. The facility’s fire clearance was approved for five (5) non-ambulatory and 1 bedridden resident. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of four (4) bedrooms and two (2) bathrooms. One (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 77 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 104.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors/ carbon monoxide were in operating condition during visit. Fire drill last conducted on 2/13/2026. Fire extinguisher was last purchased on 04/24/2025. First aid kit was observed to be complete. Continued on LIC809. Continued from LIC809. LPA reviewed three (3) staff and six (6) residents records all were current and complete. LPA requested the following documents to be submitted to CCLD by 3/25/2026. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (signature page) Liability Insurance A copy of the Administrator certificate No deficiencies observed during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 18, 2026

Allegation investigated: Staff did not prevent resident from being sexually assaulted Adult in home is touching resident inappropriately

On 1/29/2026 at 2:00pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver a complaint finding for the allegations above. LPA met with Gloria Martinez de Godsen, Caregiver and explained the reason for the visit. During the course of the investigation the Department conducted interviews with staff, resident, collected and reviewed records. Allegation: Staff did not prevent resident from being sexually assaulted During the initial interview, W1 reported that R1 stated she was sexually active with someone at the facility but did not identify the individual. S1 stated Continued on LIC9099C. Unsubstantiated Continued from LIC9099. that the Pittsburgh Police Department conducted a brief inquiry and determined no further investigation was necessary. The LPA reviewed emails from R1’s conservator dated 10/23/2025 indicating no concerns regarding abuse or R1’s safety and dated 10/24/2025 noting that R1’s primary care physician would attempt to flag her chart for provider awareness. Staff interviews (S1, S2, S3, S5, and R2) confirmed there is only one male staff member who regularly works at the facility, and male staff do not assist female residents with bathing, grooming, incontinence care, or enter female shared rooms; the male staff member may assist with meals or accompany residents outside. R1 was not interviewed due to diagnosis per appraisal needs and services plan dated 4-9-2025. Allegation: Adult in home is touching resident inappropriately During the initial interview, W1 reported and expressed concern that an adult in the home may be touching R1 inappropriately. W1 stated that R1 is unable to perform activities of daily living (ADLs’) including bathing and grooming independently; however, R1 stated she gets shaved but when asked who performs the shaving, she was unable to provide an answer. S1 stated that shaving is completed for hygiene purposes and to help reduce the risk of urinary tract infections. S2 stated that she performs the shaving to facilitate proper hygiene and reported that she assists R1 most of the time. S2 further stated that if she is unavailable, another female staff member aids female Continued on LIC9099C. Continued from LIC9099C. residents. LPA reviewed email from W2 dated 10/24/2025, which stated R1 can make false statements when provided leading questions due to her diagnosis. Based upon the information obtained and the interviews conducted during the investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit interview conducted and a copy of report was given.the state’s words, verbatim · CDSS document, Jan 29, 2026 · control 15-AS-20251023134127

Type of visit: Case Management - Health Checks

On 10/24/2025, at 11:35am, Licensing Program Analyst (LPA), L. Hall arrived unannounced conduct a case management health and safety check. LPA met with Gloria Martinez de Godsen, caregiver. LPA spoke with Administrator, Vivian Price, via telephone and explained the reason for the visit. During the health and safety check, LPA toured the facility including but not limited to common areas, bathrooms, bedrooms and outdoor common area. LPA observed two (2) residents in the living room watching television, one (1) resident in back yard, and the other two (2) residents in their rooms. There were three (3) staff present. LPA observed laundry being done and lunch being prepared. The facility is noted to be clean, in good repair, and clients in care appear to be safe. There is a minimum of 7-day non-perishables and 2-day perishables foods. There are no imminent health/safety concerns on today's date. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 24, 2025

Type of visit: Required - 1 Year

On 4/16/2025 at 2:25pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annul required inspection. LPA met with Caregiver, Gloria Martinez de Gosden, and explained the purpose of the visit. The facility’s fire clearance was approved for five (5) non-ambulatory and 1 bedridden resident. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of four (4) bedrooms and two (2) bathrooms. One (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 105.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors/ carbon monoxide were in operating condition during visit. Fire extinguisher was last purchased on 04/26/2023. Emergency Disaster Plan was last reviewed on 9/20224. First aid kit was observed to be complete. Fire drill was last conducted on 02/15/2025.. Continued on LIC809. Continued from LIC809. LPA reviewed three (3) staff and five (5) client records all were current and complete. LPA requested the following documents to be submitted to CCLD by 4/23/2025. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (9 pages) Liability Insurance The following deficiency was observed. At 3:30pm, LPA observed the fire extinguisher was last purchased 4/24/2025. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights and this report provided.the state’s words, verbatim · CDSS document, Apr 16, 2025

Type of visit: Required - 1 Year

On 4/09/2023 at 2:45pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced 1-Year Required inspection. LPA met with Caregiver, Florin Jervoso and explained the purpose of the visit. The Administrator, Vivian Price, arrived at 3:20pm. The Administrator currently holds a certificate (#6017788740) that expires on 06/19/2024. The facility’s fire clearance was approved for five (5) non-ambulatory and 1 bedridden resident. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of four (4) bedrooms and two (2) bathrooms. One (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 103.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors/ carbon monoxide were in operating condition during visit. Fire extinguisher was last purchased on 04/26/2023. Emergency Disaster Plan was last posted on 5/16/2022. First aid kit was observed to be complete. Fire drill was last conducted on 01/15/2024. Continued on LIC809. Continued from LIC809. Three (3) staff records were reviewed, complete and current. All five (5) Client records were reviewed. LPA requested the following documents to be submitted to CCLD by 4/16/2023. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 9, 2024