Brookhaven Al

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 9:05 A.M., LPA met with Licensee/Administrator Gulira Atakeeva and back up administrator, Amanbek Atakeev. Entrance interview conducted. Beginning at 9:25 A.M., the LPA, along with back up 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. The facility serves residents with dementia, and the auditory alarms on the exit doors functioned properly at the time of visit. Please note: the facility is a 2-story house; the upstairs area is inaccessible to residents in care and is used for staff only, therefore was not observed. The following was observed in the downstairs area: Hardwired combination smoke and carbon monoxide detectors were tested at 11:05 A.M. and were functional at the time of the visit. Fire extinguisher was observed to be fully charged and last serviced on 07/12/2025. BEDROOMS: There are 3 (three) total bedrooms, all of which are designated for shared resident use. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Continued on LIC 809 Continued from LIC 809 RESTROOMS: The LPA observed 2 (two) restrooms in the facility; 1 (one) is for shared use and 1 (one) is designated for private resident use. Resident restrooms were observed to be clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. Hot water temperature was measured in both restrooms and measured within the required range. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. A fireplace was observed to be inaccessible to residents in care. The facility maintained a temperature of 71 degrees. LPA observed cameras throughout the common areas only. Facility provides sufficient space to accommodate both indoor and outdoor activities. LPA observed a working phone available for residents use whenever needed. OUTDOOR SPACE: The backyard has a covered outdoor area equipped with furniture for residents’ use. Facility has a side gate observed to be self-closing and self-latching gate with clear passageways for emergency exit use. All exits and passageways were observed to be free of hazards. The facility does contain a pool, which was observed to be gated and locked in compliance with regulation at the time of the visit. KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. LPA conducted a review of expiration dates on product labels. Knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. At 9:50 A.M. hot water measured at 110.8 degrees Fahrenheit. Garage/Laundry room: The facility has a laundry room. The laundry room leads to the garage where cleaning supplies and disinfectants are kept. The garage remains locked and inaccessible to the residents in care. LPA observed a low supply of emergency water, extra food and additional PPE supplies are stored. During today’s visit a staff purchased additional emergency water supplies to ensure compliance. Technical Violation (TV) issued. Continued on LIC 809-C Continued from LIC 809-C RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. Four (4) resident records were reviewed. LPA observed that Resident #1 (R1’s) most recently Needs and Services Plan was dated 10/25/2024, and the facility did not have an updated form on file. Four (4) staff files reviewed were complete and contained all required documents. MEDICATION REVIEW: Medications review began at approximately 12:30 P.M. Medications are centrally stored and locked in a file cabinet inside a pantry in the kitchen area. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications were observed to be maintained and administered in compliance with regulation at the time of the visit. However, LPA observed that Resident #2 (R2) was missing their prescribed Senna medication for daily constipation. The administrator stated that R2’s family member had been notified of the low supply of the medication, that the last dosage was administered on 12/16/2025, and that the facility was awaiting a refill from R2’s family member. During the visit, the administrator contacted R2’s family member, who agreed to deliver the medication the same day. Technical violation (TV) issued. During today's visit, LPA gathered the following items: LIC 500 and a copy of the facility's liability insurance. LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and updated annually, at the time of the visit. Emergency drills are conducted quarterly, with the last drill documented on 11/02/2025. The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or CA Health and Safety Code. Failure to correct the deficiency 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, Dec 17, 2025

Allegation investigated: Staff did not respond to resident's requests for assistance in a timely manner Licensee retained resident requiring a higher level of care

Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced subsequent complaint visit to deliver finding for the allegations listed above. Upon arrival LPA met with back-up administrator, Amanbek Atakeev, and explained the reason for the visit. The administrator, Gulira Atakeeva, was unavailable during today's visit, but authorized the back-up administrator to sign today's report. Entrance interview conducted. During the initial visit LPA and back-administrator toured the physical plant. LPA interviewed staff, Resident #1, hospice aide and hospice nurse and reviewed and obtained pertinent documents relevant to the investigation. During today’s visit a brief physical plant tour was conducted to ensure there are no health and safety concerns, and the facility is in compliance with Title 22 regulation. The following was determined: Continued on LIC 9099-C Unsubstantiated Continued from LIC 9099-C Regarding allegation “Staff did not respond to resident's requests for assistance in a timely manner” as it was reported that during nighttime hours, staff do not respond to R1’s calls for assistance. The RP believes that staff may be sleeping during their shift, resulting in delays in providing care. To investigate the allegation, LPA Conway conducted interviews with R1, R1’s Power Of Attorney (POA), facility staff and the RP, as well as a review of facility documentation. During interviews, facility staff denied sleeping during overnight shift and reported that R1 rarely uses the call system, particularly during the night, as R1 believes they are still able to get up without assistance. Staff indicated that response times typically average 15 minutes, depending on whether staff are already assisting other residents at the time. Staff further stated that R1 is monitored every two (2) hours, including at night, or more frequently if necessary. R1 was interviewed and stated that staff generally respond in a timely manner when assistance is requested, although at times the response may take longer if staff are occupied. Interviews with other credible witnesses confirmed that R1 often avoids calling for help even when assistance is needed, as R1 prefers to remain independent. It was also brought to LPA’s attention that R1 does not like to carry their emergency call pendant around their neck, which limits their ability to request assistance promptly. Multiple individuals described R1 as reluctant to ask for help and at times disregarding the need to use the call system when support is necessary. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “Staff did not respond to resident's requests for assistance in a timely manner” is deemed unsubstantiated at this time. Regarding allegation “Licensee retained a resident requiring a higher level of care” it was reported that the RP’s expressed concern that R1 should reside in a medical facility with licensed nurses available at all times, rather than in a Residential Care Facility for the Elderly (RCFE). To investigate the allegation, the LPA conducted staff and resident interviews, reviewed records, and obtained information from the hospice agency providing services to R1. Continued on LIC 9099-C Continued from LIC 9099-C Record reviews and interviews revealed that R1 is visited by a Hospice Nurse (HN) every Tuesday and Friday to provide comfort care related to their medical diagnosis. In addition, a Hospice Aide (HA) visits every Monday and Thursday from 7:00 A.M. to 1:00 P.M to provide showers twice per week. The aide also supports R1 with activities, such as walking and exercise, as part of their hospice care plan. During an interview, the HN stated that R1 does not require ongoing skilled nursing care, does not have an active infection, does not present with behaviors that disrupt other residents, and does not have bedsores. The HN further explained that in the event of a medical change or emergency, the hospice agency has on-call nurses available 24/7 to respond to the facility and provide care as needed. Interviews with facility staff, including the back-up administrator, confirmed that staff are able to meet R1’s current care needs. Staff reported that R1 is monitored every two (2) hours, or more if necessary. LPA Conway interviewed R1 directly. R1 did not report any issues or concerns with the care and services being provided. No unmet needs have been observed by LPA. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “Licensee retained resident requiring a higher level of care” is deemed unsubstantiated at this time. No citations issued. Exit interview was conducted. A copy of the report was provided via e-mail.the state’s words, verbatim · CDSS document, Sep 18, 2025 · control 29-AS-20250908100909

Allegation investigated: Staff did not ensure resident received adequate nutrition Staff did not assist resident with bathing as needed

Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced 10-day complaint visit to investigate the allegations listed above. Upon arrival LPA met with back-up administrator, Amanbek Atakeev, and explained the reason for the visit. The administrator, Gulira Atakeeva, was unavailable during today's visit, but authorized the back-up administrator to sign today's report. Entrance interview conducted. During today’s visit from 10:15 A.M. – 2:30 P.M. LPA and back-administrator toured the physical plant to ensure there are no health and safety concerns, and the facility is in compliance with Title 22 regulation. LPA interviewed staff, Resident #1, hospice aide and hospice nurse and reviewed and obtained pertinent documents relevant to the investigation. Please note that LPA Conway made attempts to contact Reporting Party (RP) upon receipt of this complaint, but RP was not available to provide additional details. The following was determined: Continued on LIC 9099-C Unsubstantiated Continued form LIC 9099 Regarding the allegation: “Staff did not ensure resident received adequate nutrition” it was alleged that Resident #1 (R1) is only receiving three feedings per day and is not getting enough nutrition. R1 has a documented medical diagnosis of swallowing difficulties involving the mouth and throat (Sever Dysphagia). Due to this condition, R1 was prescribed a liquid special diet “NPO” (nil per os, nothing by moth) and long-term use of artificial nutrition upon admission to the facility in August 2024. The current hospice plan of care indicates that R1 is to be fed three (3) times daily using 4 to 4 1/2 cartons of Jevity 1.5 Calories per mL. of a doctor-prescribed liquid diet containing complete balanced nutrition and fiber. The Hospice Nurse (HN) stated that R1 is capable of communicating any discomfort or intolerance during feeding sessions, and that R1 remains alert, oriented and active throughout the day, including exercising and taking short walks. LPA requested weight logs and was informed by the HN that R1 is weighed approximately once every two (2) weeks. Records provided show an average weight of 137.5 as of September 12, 2025, with an increase in muscle mass based on latest measurement. At admission, R1 weighed 128 lbs. In an interview, R1 expressed satisfaction with the amount of liquid nutrition received, though R1 stated they would prefer solid food if possible. R1 also demonstrated understanding of their medical condition and dietary requirements. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violations occurred; therefore, the allegations “Staff did not ensure resident received adequate nutrition” is deemed unsubstantiated at this time. Regarding the allegation of “Staff did not assist resident with bathing as needed” it was reported that Resident #1 (R1) often becomes sweaty; however, staff provide showers twice a week. Back up administrator reported that R1 is receiving hospice services, which include bathing twice a week. R1 is being seen by Hospice Nurse (HN) who visits every Tuesday and Friday, and a Hospice Aide (HA) who visits every Monday and Thursday. The HA provides showers. During today’s visit, the HA was present at the facility assisting R1. In an interview, the HA confirmed that R1 receives two (2) full showers each week in accordance with their established care plan. The aide, who has been caring for R1 since March 2025, denied ever observing R1 soiled, unclean, or with body odor. Continued on LIC 9099-C Continued on LIC 9099-C Additional staff interviews reflected that caregivers assist R1 with bathing support as needed, including when R1 is sweating or after an “accident”. LPA conducted a private interview with R1 in their room. R1 stated that they would like to receive full showers more frequently but acknowledged that they have not made this request to caregivers, the administrator, agency nurses, or the back-up administrator. During observation, LPA noted that R1 appeared clean-shaved, wearing a clean shirt and no body odor was detected. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violations occurred; therefore, the allegations “Staff did not assist resident with bathing as needed” is deemed unsubstantiated at this time. Exit interview was conducted. A copy of the report was provided via e-mail.the state’s words, verbatim · CDSS document, Sep 15, 2025 · control 29-AS-20250908100909

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.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 9:30 A.M., LPA met with Licensee/Administrator Gulira Atakeeva. Entrance interview conducted. Beginning at 9:50 A.M., the LPA, along with Licensee/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. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Please note: the facility is a 2-story house; the upstairs area is inaccessible to residents in care and is used for staff only, therefore was not observed. The following was observed in the downstairs area: Hardwired combination smoke and carbon monoxide detectors were tested at 11:30 A.M. and were functional at the time of the visit. Fire extinguisher was observed to be fully charged and last serviced on 02/20/2024. BEDROOMS: There are 3 (three) total bedrooms, all of which are designated for shared resident use. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. LPA observed that all exterior exit doors of resident's rooms were locked at the time of the visit. RESTROOMS: The LPA observed 2 (two) restrooms in the facility; 1 (one) is for shared use and 1 (one) is designated for private resident use. Resident restrooms were observed to be clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. Between 10:04 A.M. and 10:16 A.M., hot water temperature was measured in both restrooms and measured within the required range. Continued on LIC 809-C Continued from LIC 809 COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. A fireplace was observed to be inaccessible to residents in care. The facility maintained a comfortable temperature of 70 degrees. LPA observed a ring doorbell, administrator did not know that a waiver is required to have ring doorbell. LPA did not cite but advised the licensee to submit a waiver for the Ring doorbell due to the audio component, to update plan of operation and admission agreement. LPA observed cameras throughout the common areas only. Facility provides sufficient space to accommodate both indoor and outdoor activities. LPA observed a working phone available for residents use whenever needed. OUTDOOR SPACE: The backyard has a covered outdoor area equipped with furniture for resident use. Facility has a side gate observed to be self-closing and self-latching gate with clear passageways for emergency exit use. All exits and passageways were observed to be free of hazards. The facility does contain a pool, which was observed to be gated and locked in compliance with regulation at the time of the visit. KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. LPA conducted a review of expiration dates on product labels. Knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. At 10:13 A.M. hot water measured at 109 degrees Fahrenheit. Garage/Laundry room: The facility has a laundry room. The laundry room leads to the garage where cleaning supplies and disinfectants are kept. LPA observed extra food and additional PPE supplies are stored. The Garage remains locked and inaccessible to the residents in care. RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. Continued on LIC 809-C Continued from LIC 809-C Four (4) resident records were reviewed. LPA observed two (2) residents physician’s report indicated their ambulatory status as bedridden. Administrator stated that there is a mistake on Resident’s #1 (R1) physicians report. At the time of the visit R1 was watching TV in the living room. At lunch time R1 was assisted by staff to transfer from the living room to the kitchen table using a wheelchair. LPA believes that R1 is non-ambulatory. Administrator will submit an updated physician’s report for R1. Five (5) staff files reviewed were complete and contained all required documents. MEDICATION REVIEW: Medications review began at approximately 1:10 P.M. Medications are centrally stored and locked in a file cabinet inside a pantry in the kitchen area. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications for all residents were observed. LPA observed that hospice Resident #2 (R2) has a G tube. Administrator stated that staff will feed and administer medication to R2 daily as prescribed. Hospice care plan signed on 08/09/2024 states that hospice responsibility is to manage any hospice-related medications that must be given by injection/infusion. All other residents' medications were observed to be maintained and administered in compliance with regulation at the time of the visit. During today's visit, LPA gathered the following items: LIC 500 and a copy of the facility's liability insurance. LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and updated annually, at the time of the visit. Emergency drills are conducted quarterly, with the last drill documented on 11/05/2024. The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or CA Health and Safety Code. Failure to correct the deficiency 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, Dec 12, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 08:40AM. LPA met with Licensee/Administrator Gulira Atakeeva. Entrance interview conducted. Beginning at 08:52AM, the LPA, along with Licensee/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. Please note: the facility is a 2-story house; the upstairs area is inaccessible to residents in care and is used for staff only, therefore was not observed. The following was observed in the downstairs area: Hardwired combination smoke and carbon monoxide detectors were tested at 11:40AM and were functional at the time of the visit. Fire extinguisher was observed to be fully charged and last serviced on 02/15/2023. BEDROOMS: There are 3 (three) total bedrooms, all of which are designated for shared resident use. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: The LPA observed 2 (two) restrooms in the facility; 1 (one) is for shared use and 1 (one) is designated for private resident use. Resident restrooms were observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was measured in the shared resident restroom and measured within the required range. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. A fireplace was observed to be inaccessible to residents in care. Report Continued on LIC 809-C OUTDOOR SPACE: The backyard has a covered outdoor area equipped with furniture for resident use. All exits and passageways were observed to be free of hazards. The facility does contain a pool, which was observed to be gated and locked in compliance with regulation. KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. The facility has separate locked laundry room and locked garage. Garage was observed and contained extra food, emergency food, cleaning supplies and storage, as well as another laundry area. RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. 5 (five) resident records were reviewed. 2 (two) residents with a diagnosis of dementia did not have current annual medical assessments. The medical assessment for Resident #1 (R1) was dated 09/13/2022 and the medical assessment for Resident #2 (R2) was dated 03/14/2022. 5 (five) staff files reviewed were complete and contained all required documents. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and updated annually, as required. Emergency drills are conducted quarterly, with the last drill documented on 10/07/2023. MEDICATION REVIEW: Medications for 2 (two) residents were observed. Both 2 (two) of 2 (two) residents' medications were observed to be maintained and administered in compliance with regulation. INTERVIEWS: Throughout the visit, LPA interviewed 2 (two) residents. During today's visit, LPA gathered the following items: LIC 500 and a copy of the facility's liability insurance. The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or CA Health and Safety Code. Failure to correct the deficiency 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, Dec 8, 2023