Mesa Care

Type of visit: Required - 1 Year

At 8:15am on 09/25/2025, Licensing Program Analyst (LPA) Jeffries arrived to the facility unannounced to conduct the facility annual inspection. LPA met with Administrator, Valentyna Polunetss, announced who he is and the reason for the visit. This facility is a seven bedroom, three bathroom, living room, dining room, kitchen and den. There is a large fenced back yard with seating and shade for activities and visitors. Six of the bedrooms are single occupancy resident rooms, the seventh bedroom is designated as a staff bedroom. Medications are locked and stored in the laundry room off the kitchen. There is a 1st aide kit also stored in the medication cabinets. LPA observed a fire extinguisher primed and in the green located in the laundry room. LPA observed at least two days of perishable foods, and at least seven days of non perishable food for six residents and staff. LPA observed resident bedrooms to have linins and furniture per regulation requirements. LPA tested water temperature throughout the faculty to be in regulation parameters of 105*-120*(f). LPA noted that all bathrooms have liquid soap, paper towels, non slip mats and working commodes. LPA noted that the hallways, passage ways and doors were all feel and clear of obstacles and debris. LPA noted that the facility was clean and in good repair. LPA conducted a cursory review of facility Emergency Disaster Plan, Infection Control Plan, Liability Insurance, Staff and Resident files, and Centrally Stored Medication Records (CSMR). LPA reviewed and noted that all staff are background cleared. LPA noted that both facility Administrators had current Administrator Certificates. LPA notes that the physical inspection of the facility reviled no violations or citations. Administrator and LPA conducted a full review of the facility care tools modules. LPA noted no violations or citations during the care tools review. At this time there are no violations or citations as a result of the annual facility inspection. Exit interview, report read, and report provided.the state’s words, verbatim · CDSS document, Sep 25, 2025

Allegation investigated: Resident had bruising as a result of neglect and/or rough handling. Medication was not given as prescribed. Staff did not meet resident’s needs. Staff were rude to resident. Resident’s personal rights were violated. Facility is not providing activities.

Licensing Program Analysts (LPAs) Brian Phillips and Kristin Kontilis conducted a subsequent complaint visit to issue final findings on this investigation. During the investigation, LPA Kontilis conducted an initial visit on 1/9/2024 from 11:40 am to 4:00 pm. LPA toured the facility, conducted interviews, and obtained relevant documents. On 10/8/2024 from 9:30 am to 2:00 pm, LPA conducted additional interviews and noted observations during the annual visit to the facility. On the allegation: Resident had bruising as a result of neglect and/or rough handling. It was alleged a resident had “defensive bruises” on their arms from “blocking.” The resident was also observed with a bruise to their left temporal area. Residents interviewed stated staff treat them like family, and there has been no rough handling. Residents interviewed stated staff had never been rough when assisting them, and all their needs were met. Staff interviewed stated they had never heard of nor witnessed residents’ personal rights being violated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time. Please continue to 9099-C, Pg 2. Unsubstantiated On the allegation: Medication was not given as prescribed. It was alleged R1 is allowed to have 3 glasses of white wine per day, but then went to the hospital and was prescribed Valium. It was alleged the wine was stopped, then both the wine and medications were discontinued. R1 indicated staff assist them with medications. Licensee stated R1 wants to drink wine, but their physician has limited it to 3 glasses per day. Licensee stated they try to redirect the resident when they have not eaten much. Licensee stated the doctor never indicated they needed to stop allowing R1 to have wine and it is their right to have wine if they want it. Licensee further stated they try to work with R1 about their drinking habits and stick to the 3 glasses per day as approved by the doctor. Licensee stated they did not withhold the Valium. Other residents interviewed stated they receive assistance with medications. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time. On the allegation: Staff did not meet resident’s needs. It was alleged staff do not meet resident’s needs. A visitor was interviewed and stated R1 appeared “unkempt” and was not getting their required physical therapy appointments. During the visits, LPA did not observe any residents unkempt. During a visit, LPA observed R1 on the phone scheduling their own appointments. Licensee stated sometimes they will help R1 schedule or dial the phone when asked, but R1 is able to schedule them independently. Residents interviewed stated the staff meet their needs. Staff interviewed stated they assist residents with all activities of daily living that are needed and cater to each individual. Staff ensure residents needs are met by talking to them and their families to create a care plan. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time. On the allegations: Staff were rude to resident and Resident’s personal rights were violated. It was alleged staff were rude when speaking at dinnertime. A visitor indicated they observed staff being rude when a resident asked for food and was told dinner is at 5 pm; however, staff did feed the resident. Visitor stated some staff have an “Eastern European accent” and sounded rude. Some residents interviewed indicated sometimes staff are rude but did not elaborate. Residents interviewed stated on one occasion, the staff did not provide dinner because they were home late and said, “you must go to bed.” Upon re-interview the resident stated staff treat them like family, they use a calm voice, and staff yelled once but resident yells Please continue to 9099-C, Pg 3. back. Resident stated people speak up because the resident’s “ears are clogged up.” Resident stated staff observe their personal rights and have never been rude. Residents interviewed stated staff were nice and they had no issues with personal rights. Another resident stated the staff would give them dinner if they were home late. Residents interviewed stated they can leave the facility when they want. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time. On the allegation: Facility is not providing activities. It was alleged residents are being isolated. LPA observed residents in the living room and at the dining table during visits. LPA observed music, puzzles, and games inside and outside the facility. Residents interviewed stated a musician comes once week, but there are few other activities. One resident initially stated there were no activities, but later stated they do their own activities like games, puzzles, and music on their own and go out of the facility with visitors. Residents stated they talk with each other a lot as an activity. During the visit, licensee was heard telling another resident they can go for a walk soon. During today's visit, Licensee stated special celebrations are held for birthdays and all holidays including family members attending with decorations and special meals. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time. Exit interview conducted. Copy of report issued at the time of the visit.the state’s words, verbatim · CDSS document, Oct 30, 2024 · control 29-AS-20240105145048

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPAs) Brian Phillips and Kristin Kontilis conducted an unannounced continuance Inspection of the above-named facility. LPAs were greeted by Co-Administrator Alex Polunets.. Administrator Valentina Polunets arrived at approximately 10:30 am. LPAs explained the purpose of the visit At the time of arrival, Co-Administrator was on duty with six residents in care. The facility is a Residential Care Facility for the Elderly (RCFE) The facility accepts residents with a dementia diagnosis; has a hospice care waiver for four residents; and a fire clearance for six non-ambulatory residents, of which two (2) can be bedridden. Currently there are three (3) residents on hospice residing in the facility. Entrance interview conducted. The facility is a one-story facility located in a residential area. LPA observed the required posting of the complaint poster and Resident’s Rights. The one-story facility was inspected for fire safety, personal accommodations, and food service. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors and floor coverings were checked. The facility was seen to be in good repair inside and outside. LPA observed the fire inspection was last conducted on 8/28/2024. LPA observed eight smoke alarms and 1 carbon monoxide detector were in good working order. Entrance into the facility leads into the common area and the dining area. The kitchen cabinets, refrigerator, stove, and counters are clean. The facility is sufficiently stocked with at least two days of perishables and seven days of non-perishables. Snacks and beverages are available for residents in care upon request. Sharps are kept in the laundry room. There are six private bedrooms and one extra bedroom. Bedrooms #5 and #7 have a private bathroom. There are two bathrooms off the facility hallway available to all residents in care. Please continue to 809-C, Pg 2.. Residents' records were reviewed. Admission Agreements, Health Screenings, Needs and Services Plans, Appraisals, Pre-Appraisals, Consent Forms, Physician's Reports have been signed and all records are current. Staff records reviewed revealed trainings are up-to-date, personnel records are current and up-to-date. Exit interview conducted. Technical assistance noted. Copy of report issued at the time of the visit.the state’s words, verbatim · CDSS document, Oct 30, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced Inspection of the above-named facility. Kelly Burley, Licensing Program Manager accompanied LPA during the visit. LPM and LPA were greeted by Staff 1 (S1). Alex Polunets arrived approximately 10:12 am. LPA explained the purpose of the visit. At the time of arrival, there was one staff on duty and six residents in care. The facility is a Residential Care Facility for the Elderly (RCFE) The facility accepts residents with a dementia diagnosis; has a hospice care waiver for four residents; and a fire clearance for six non-ambulatory residents, of which two (2) can be bedridden. Currently there are three (3) residents on hospice residing in the facility. Entrance interview conducted. The facility is a one-story facility located in a residential area. LPM and LPA observed the required posting of the complaint poster and Resident’s Rights. The one-story facility was inspected for fire safety, personal accommodations, and food service. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors and floor coverings were checked. The facility was seen to be in good repair inside and outside. LPA observed the fire inspection was last conducted on 8/28/2024. LPA observed eight smoke alarms and 1 carbon monoxide detector were in good working order. Entrance into the facility leads into the common area and the dining area. The kitchen cabinets, refrigerator, stove, and counters are clean. The facility is sufficiently stocked with at least two days of perishables and seven days of non-perishables. Snacks and beverages are available for residents in care upon request. Sharps are kept in the laundry room. There are six private bedrooms and one extra bedroom. Bedrooms #5 and #7 have a private bathroom. There is one bathroom off the facility hallway available to all residents in care. Cleaning agents are kept in a cabinet in the garage. Medications are kept in two cabinets in the facility’s laundry room. First aid supplies were observed to be in good order. Please continue to 809-C, Pg 2. Residents participate at will in music activities, puzzles, and games. From 9:31 AM through 11:35 AM, LPA intermittently interviewed residents in care. From 1:00 PM through 1:10 PM, LPM and LPA interviewed Administrator Alex Polunets. The backyard has a paved patio with a table and chairs with an umbrella, sitting area, and raised garden areas. The backyard is conducive for outdoor visitations. The front yard has garden areas and is access into the main entrance of the facility. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. The following deficiencies were observed: <At 9:33 AM, upon entering the facility, LPM and LPA observed S1 on duty providing care to six residents. LPM and LPA determined that S1 has a background clearance however is not properly associated to the facility. <At 9:37 AM, LPM observed a tray on the kitchen counter with five empty medication cups and one medication cup with 4 white medications, one yellow medication and one red medication. <At 9:37 AM, LPM observed the front right stove burner on a "low-medium" flame visibly burning and unattended by staff. A verbal warning was discussed with Administrator Alex Polunets. <At 10:29 AM, LPA noted the residents' bathroom off the hallway water temperature was measured at 127.0 degrees Fahrenheit (F). LPA noted that at the time the water temperature was measured, the temperature continued to rise. <At 10:36 AM, LPA noted the private shared bathroom between Bedrooms #5 and #7, the water temperature was measured at 128.3 degrees F. LPA noted that at the time the water temperature was measured, the temperature continued to rise. <At 11:20 AM, LPM reviewed medication records for two residents and noted facility's Centrally Stored Medication Record is not properly completed. Due to time restraints, LPA will return at a later date to continue the inspection. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. A copy of the report and appeal rights issued at the time of the visit.the state’s words, verbatim · CDSS document, Oct 8, 2024

Type of visit: Required - 1 Year

On 10/25/2023 Licensing Program Analyst (LPA) Brian Phillips arrived at the facility unannounced to conduct a required 1-Year Annual facility site inspection visit at the facility above. When the LPA arrived, they were greeted by Licensee Alex Polunets, Administrator/Licensee Valentina Polunets and informed them of the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. This facility is a Residential Care for the Elderly (RCFE) that has an age range of 60 years and older for all residents in care. The facility fire clearance is approved for approved for 6 non-ambulatory residents, 2 of which may be bedridden. A hospice waiver is approved for 4 residents. KITCHEN(S): The facility has a main kitchen for residents of the facility, and a connected dining room. The LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored in the kitchen in a locked drawer inaccessible to residents. Kitchen appliances were in operable condition and looked clean/in good repair. The LPA observed perishable items in good condition, with proper expiration dates precluding the perishable items from expiring. The facility has a sufficient supply of perishable and non-perishable food, which would last 7 days. Additional perishable food items were maintained on a shelf and/or an extra freezer. The hot water temperature was measured in the kitchen at an appropriate temperature as per the regulation. Heating devices such as stoves are inaccessible to residents, as are sharps/other items that could constitute a danger to residents. The kitchen was clean and sanitary, with covered trashcans and operating ventilation systems. No toxic substances are stored in any food preparation or storage area, and all cleaning supplies for the kitchen are kept in a separate area than the food supplies. The freezer and refrigerator were both in the appropriate temperate Fahrenheit. There is enough tableware and utensils for all residents living in the facility, and enough equipment for the storage, preparation, and service of food. Continued on 809-C COMMON AREAS: At the time of the visit, the living room and dining room were observed to be appropriately furnished, with all furniture in good condition. The entrance to the facility has an area with sign in materials as well as COVID screening procedures. The facility itself is a single-story personal residence home converted into an RCFE. There is a living room for residents off the main dining room that is appropriately furnished, with all furniture being in good condition. There is a fireplace on the premises, which is covered and inaccessible. There are activity materials in the common areas of the facility in good repair and operating condition. The facility maintained a comfortable temperature at the time inspected. Smoke detectors and carbon monoxide detectors were tested and operational at the time of the visit in each of the buildings inspected. The fire extinguisher was fully charged and last serviced in 2023. The LPA observed required postings throughout all common spaces including Resident Personal Rights and Resident Council Rights. There are activity supplies and equipment, including reading materials for the residents in all common areas inspected. All window screens were in good repair in all the areas comprising the facility. There is appropriate lighting in all the common areas of the facility. All passageways through the common areas of the facility were free of obstruction, and all interior areas are well-lit with sturdy hand railings/stair chair accessibility devices. This facility is one (1) story throughout and therefore there are no stairways for residents to utilize. As the facility has less than 16 residents and is single-story, so there is no signal system in place at the time of the inspection by the LPA. OUTSIDE/LAUNDRY/MISCELLANEOUS: The front outdoor area of the facility consists of a front courtyard with an open porch with tables and chairs. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. Outdoor activity spaces are completely enclosed by a fence and gates or walls. Outdoor activity spaces in the backyard are equipped with furniture for resident use including a patio with an umbrella for shade. All outdoor areas with stairways, inclines, ramps, or open porches have accessibility ramps for residents, and are well-lit. There were no bodies of water noted. The laundry room of the facility contains additional supplies/emergency supplies. The designated laundry room of the facility is where cleaning products are stored, which are kept locked and inaccessible to residents. The laundry room is accessible from the common areas of the facility and is comprised of a small hallway adjacent to the kitchen. There was emergency food and water in storage area of the garage which was observed to be in good condition. Cleaning supplies, disinfectants, and other items that could pose a danger to residents are kept in areas inaccessible to residents. There is a first aid kit that includes sterile dressings, bandages, thermometers, scissors, tweezers, and a first aid manual. Continued on 809-C LPA noted that outside in the back yard is completely enclosed by two gates on either side of the facility and has appropriate furniture for residents as well as shade. LPA did not observe any noticeable outdoor hazards. The facility is completely enclosed with auditory delayed egress exits into and out of the facility. Auditory delayed egress devices monitor all exits from the interior of the facility, and the outdoor gates to leave the facility. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There are 7 designated individual resident rooms in the facility, and storage areas for clean linens, towels, pillows, etc. Each resident bedroom has a single bed, night stands, and lights and night stand lamps to provide sufficient lighting. Each closet in all the resident rooms has extra pillows, clean/fresh linens, and appropriate incontinence materials if applicable for any resident. The resident bedrooms are big enough for all beds, furniture, and any resident assisting device a resident might need such as a wheelchair or a walker. Each room has sufficient lighting for each resident. RESTROOMS: The facility restrooms were sanitized and in operating condition while the LPA toured the facility. There are 3 resident bathrooms total in the facility, with 3 shared bathrooms in the common areas of the facility and 1 bathroom being a private resident bathroom in a resident bedroom. All restrooms inspected had assisting equipment for residents including grab bars and/or non-skid surfaces. The bathrooms were sufficiently stocked with soap, paper towels, and additional supplies; towels and washcloths are not shared. The hot water temperature was measured in the restrooms at the appropriate degrees Fahrenheit as per the regulations between 105-120 degrees. As the facility only contains 5 residents at the time of inspection, there is at least 1 toilet and sink for each 3 residents, and at least 1 bathtub/shower for each 3 residents. Nightlights are installed in the hallways outside of the common area restrooms. RECORDS: The facility keeps confidential storage of personnel records and resident records on-site at the facility. Personnel records reviews were reviewed for, but not limited to Personnel records, Health assessments with Tuberculosis (TB) test results, Personnel Action Notice, Job Description with date of employment, Employee Rights, Criminal record Statements/Criminal record clearances, first aid/CPR certification that is not expired, and the appropriate training. All staff member personnel records had the appropriate documentation with no expiration of any training. Continued on 809-C Resident records were reviewed for Pre-Admission/Placement appraisals, Physicians Reports, Consent Forms, Personal Rights for Residents, Emergency Information, Release of Medical Information, Needs and Services Plan (ANS), Resident Assessments, Self-management of medications if applicable, Medication Orders, and Medication Logs. All resident records reviewed by the LPA had the appropriate documentation with no missing or incomplete information. MEDICATIONS: The facility maintains a locked centralized storage area for resident medications. The LPA observed the centrally stored medications as well as the Centrally Stored Medication and Destruction Record. Centrally Stored Medications are in a locked cabinet in the laundry room area inaccessible to residents. LPA audited the medications for residents and noticed no irregularities or issues concerning the dispensing of medications or the logging of medications. The medications in the facility were labeled appropriately with no additional or prohibited markings by the facility. INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening and a sanitation station. The staff members will keep up signs that promote good hand hygiene and symptoms of COVID. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. FACILITY DOCUMENTATION: There are required postings throughout the facility, including emergency exiting plans with necessary telephone numbers. The facility has copies of applicable documentation including Applicant Information, Designation of Facility Responsibility, Affidavit Regarding Client/Resident Cash Resources, Surety Bond, Personnel Report, Personnel Record, Health Screening Report, Emergency Disaster Plan, Residential Infection Control Plan, Facility Sketch, Plan of Operation, Control of Property, The Job Description for Each Staff Position, Personnel Policy, In-Service Training for Staff, Facility Program Description, Rules of Discipline/Personal Rights, Admission Agreement for Residents, Theft & Loss Policy, and Job Description for the Administrator. No deficiencies cited. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 25, 2023