Pacific Breeze Home II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Irina Maroussenko and explained the reason for the visit. The Administrator's Certificate expires on June 14, 2028. The facility is licensed for 6 non-ambulatory residents with a hospice waiver for 4. The facility is a single story home, with 3 bathrooms, 6 bedrooms (1 is for staff), 2 car garage, living room, laundry room dining room and kitchen. LPA and Administrator toured the facility. LPA observed the See Something, Say Something poster posted in the main entry way of the facility. LPA observed the fireplace in the living room is screened. The Administrator reported that the fireplace is never used. LPA observed extra linens are stored in the hall closet. LPA observed the 4 burner gas stove lights unassisted. The knobs on the stove have been removed for safety. LPA observed the kitchen has a 2 day perishable and a 7 day non-perishable food supply in the kitchen. The fire extinguisher in the kitchen is fully charged. Knives are kept locked in a box on the kitchen counter. Medication is stored in a medication cart that is kept locked. LPA observed all resident rooms had the required furnishings and bedding. LPA observed 4 out of 6 residents had bed rails (no full bed rails), all 4 residents had physician's orders for bed rails. LPA observed all 3 bathrooms are clean and operational. Hot water measured 107.2 degrees Fahrenheit in all 3 bathrooms. LPA observed the garage is kept locked and used for storage. LPA observed a 3 day emergency supply of food and water stored in the garage. LPA and Administrator toured the outside of the facility. There is a table and chairs with an umbrella in the front courtyard for residents to sit outside. The backyard has two sitting areas for residents to sit outside. No bodies of water observed in the backyard. The exit gate is operational and self closing. No obstacles or hazards observed in the backyard. The last disaster drill was conducted on June 10, 2026. Smoke detectors/carbon monoxide detectors tested operational. LPA inspected the first aid kit. The first aid kit has all the required elements. LPA reviewed 6 resident files and medication, no discrepancies observed. LPA reviewed 2 staff files. Both staff members are background cleared and associated to the facility. Both staff have the required training and CPR/First Aid training. The facility has an internet device (tablet) for dedicated resident use. No deficiencies are being issued as a result of this visit. Exit interview conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Jul 15, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Irina Maroussenko and explained the reason for the visit. The Administrator's Certificate expires on June 14, 2026. The facility is licensed for 6 non-ambulatory residents with a hospice waiver for 4. The facility is a single story home, with 3 bathrooms, 6 bedrooms (1 is for staff), 2 car garage, living room, laundry room dining room and kitchen. LPA and Administrator toured the facility. LPA observed the See Something, Say Something poster posted in the main entry way of the facility. LPA observed the 4 burner gas stove lights unassisted. LPA observed the kitchen has a 2 day perishable and a 7 day non-perishable food supply in the kitchen. The fire extinguisher in the kitchen is fully charged. Knives are kept locked in a box on the kitchen counter. Medication is store in a locked cart. LPA observed all resident rooms had the required furnishings and bedding. LPA observed all 3 bathrooms are clean and operational. Hot water measured 112.1 degrees Fahrenheit in all 3 bathrooms. LPA observed the garage is kept locked and used for storage. LPA observed a 3 day emergency supply of food and water stored in the garage. LPA and Administrator toured the outside of the facility. There is a table and chairs with an umbrella in the front courtyard for residents to sit outside. The backyard has two sitting areas for residents to sit outside. No bodies of water observed in the backyard. The exit gate is operational and self closing. No obstacles or hazards observed in the backyard. The last disaster drill was conducted on July 10, 2025. Smoke detectors/carbon monoxide detectors tested operational. The first aid kit has all the required elements. LPA reviewed 5 resident files and medication, no discrepancies observed. LPA reviewed 3 staff files. All 3 staff are background cleared and associated to the facility. All 3 staff have the required training and CPR. The facility has an internet device (tablet) for dedicated resident use. No deficiencies are being issued as a result of this visit. Exit interview conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Jul 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Irina Maroussenko and explained the reason for the visit. Facility is a single story home with 3 bathrooms, 6 bedrooms, 2 car garage, living room, laundry room dining room and kitchen. LPA and Administrator toured the facility. LPA observed the See Something, Say Something poster posted in the main entry way of the facility. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the fire extinguisher is fully charged. LPA observed the kitchen is clean and organized. LPA observed all cleaning supplies are kept locked in the laundry room. LPA observed knives are kept locked in a lock box (safe) on the kitchen counter. LPA and the Administrator toured the resident rooms. 4 bedrooms are private, 1 is shared and 1 is for staff. LPA observed all resident rooms had the required furnishings and bed linens. LPA observed all bathrooms are clean and operational. Hot water measured 117.2 degrees Fahrenheit. Smoke detectors/carbon monoxide detectors tested operational. LPA observed the fireplace in the living room is not screened. The Administrator reported that the fireplace is not in use. LPA observed the facility has a laptop for resident use only. LPA observed all medications are kept locked in a medication cart in the staff room. LPA and the Administrator toured the backyard and garage. The garage is kept locked and inaccessible to residents. The garage is used for storage of extra supplies and food. No bodies of water observed in the backyard. There is a table with chairs to sit outside. In the front courtyard of the house there is a table with an umbrella and chairs. The exit gate for the backyard is operational. No obstacles or hazards observed inside or outside of the facility. LPA reviewed 5 resident files and medications, no discrepancies observed. LPA reviewed 2 staff files, no discrepancies observed. All staff had the required training and CPR/First Aid training. LPA inspected the first aid kit. The first aid kit had all the required elements. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Jul 24, 2024

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.