Serenity Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required Inspection and met with Erica Campos, Lead Staff and Aida Reznik, Licensee arrived later. There are three residents receiving hospice services. Annual fees are current. Required postings observed. LPA/staff initiated a tour of the facility at 9:00 am and made the following observations: Facility was a comfortable temperature, well lit and passageways were free from obstructions. Resident rooms were furnished per regulation. There are portable heaters observed in resident's rooms. Per staff, the room is shared by two residents who have different preferences regarding the temperature of the room (technical violation issued). Water temperature in bathrooms used by residents measured at 108.1, 114.8 and 115.3 degrees F which are all within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. However, bathroom's and resident's garbage cans do not have well-fitted covers to prevent the spread of any communicable disease. Last year, LPA discussed with the Licensee the importance of having garbage cans with covers and technical violation was issued. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked in the medication room. Four out of six fire extinguishers were last inspected January 2025. According to lead staff, it appears like the remaining two fire extinguishers were missed when the vendor came to service the other extinguishers. Facility has a centralized smoke alarm and sprinkler system that is maintained by a vendor. The most recent inspection was conducted November 2025. Carbon monoxide detectors were tested and operational. Exit doors have auditory alerts that were functional at time of visit. Each resident has a pendant to alert staff if the resident needs assistance. Last Disaster Drill was conducted on September 12, 2025. Continues on LIC809C... Continued from LIC809... LPA initiated file review at 9:30 am of 5 staff files and 7 resident files were reviewed. All staff have required First Aid and CPR certificates and annual continuation training hours were complete. All residents' medical assessments were updated. Two out of seven resident's care plans were not signed by their responsible party as required per regulation. Administrator Certificate for Licensee/Administrator Aida Reznik, 7010118740, expires on 4/11/27. Activity Calendars and Weekly Menus posted. Medication and medication records were reviewed. Licensee previously provided updates of the following: Designation of Administrative Responsibility (LIC308), Personnel Record (LIC500) and Liability Insurance Certificate. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with Licensee and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 2, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: -Lack of supervision.

Licensing Program Analysts (LPAs) Cuadra and Contreras arrived unannounced to deliver findings regarding the above allegation and met with Maritza Pray (Back up Administrator). The Department received an allegation of lack of supervision. Per Reporting party on 12/13/24 resident (R1) fell out of bed during the night and were left there for hours until shift change came in the morning for assistance. R1 was observed with a visible bruising on left arm. On 12/2/24 resident (R2) waited for long time for assistance (no specific time was provided) R2 was observed with bruising on upper left head and wrist. Based on interviews conducted with staff (S1, S2, S3 & S4), they indicated that there are residents including R1 and R2 who usually do not sleep during the night and their protocol includes keeping an eye on them, offer them food or walk with them. The Department received a self-report notifying that R1 fell out of their bed and was transported to the hospital for further evaluation and did not return to the facility. Continued on LIC9099C... Unsubstantiated Continued from LIC9099... Regarding call system staff indicated that the process consists in the alarm located in the hallway by the medication room will alert the staff that a resident needs assistance, the device will state the room number that needs assistance, when the residents pull their alarm pendant that it is usually maintained on their neck, which it was confirmed by residents (R3 & R4) interviewed by LPA; Then the staff who will assist the resident will turn off the alarm and will go help the resident. Although, staff revealed that call responses are not documented by the facility, they ensured that they are responding timely to calls from residents in care. During interviews with staff, LPA learned that R1 had a tendency to pull their pendant and when staff arrives to their room, they will pretend like if they were sleeping. Residents interviewed by LPA stated that they are been assisted by staff when needed and they were able to locate their pendant when they need to call staff for assistance. LPA attempted to speak with R1, but they are no longer residing at the facility. R2 refused to talk with LPA. Based on records review, the facility documents medication, care, get out of bed and food services refusal in a log created by the facility, LPA was provided with log for the month of December 2024 and January 2025, where it was confirmed that both residents tend to refuse services and care provided by the staff. Resident’s (R1 and R2) physician report confirms that they need assistance with self-care including bathing and dressing. Although, LPA reviewed personnel report (LIC500) and timesheets for the month of December 2024 did not indicate any supportive evidence that there was a lack of supervision to residents in care. LPA is unable to determine if there had been any time when staff did not respond to resident’s calls at any prior date. A finding that the complaint allegation occurs of lack of supervision is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Mar 4, 2025 · control 21-AS-20241209155517

Type of visit: Required - 1 Year

Licensing Program Analysts, (LPAs) Cuadra and Frank arrived unannounced to conduct an Annual Required Inspection and met with Maritza Pray, Back up Administrator and Aida Reznik, Licensee arrived later. Upon LPA's arrival a cart containing cleaning supplies and other items that could pose a risk were observed unattended on the hallway. LPAs inquired with staff and were told that staff was cleaning that part of the facility. However, it took staff ten minutes to come back to take the cart away. LPA/Licensee initiated a tour of the facility at 9:30 am and made the following observations: Facility was a comfortable temperature, well lit and passageways were free from obstructions. Resident rooms were furnished per regulation. There was a portable heater in 1 out of 5 rooms inspected. Per Licensee, the room is shared by two residents who have different preferences regarding the temperature of the room (technical violation issued). Water temperature in bathrooms used by residents measured at 111.2, 114.8 and 114.9 degrees F which are all within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. However, bathroom's garbage cans do not have well-fitted covers to prevent the spread of any communicable disease (technical violation issued). Facility has at least two days of perishable and one week of non-perishable foods. LPA/Licensee observed that kitchen outside door did not have a screen door to prevent insects and have a conversation with Licensee regarding door screen needed to be installed in the kitchen outside door (technical violation issued). Medications were centrally stored and locked in the medication room. Activity Calendars and Weekly Menus posted. Required postings observed. Annual fees are current. Fire extinguishers were last inspected December 21, 2023. Facility has a centralized smoke alarm and sprinkler system that is maintained by a vendor. The most recent inspection was conducted December 11, 2024. Carbon monoxide detector was tested and operational. Exit doors have auditory alerts that were functional at time of visit. Each resident has a pendant to alert staff if the resident needs assistance. Last Disaster Drill was conducted on December 5, 2024. Continues on LIC809C... Continued from LIC809...File review was initiated at 10:00 am. 5 staff files and 5 resident files were reviewed. Staff have required First Aid and CPR certificates and annual continuation training hours were complete. All residents' medical assessments and care plans were updated/signed by a responsible party as required per regulation. Administrator Certificate for Licensee/Administrator Aida Reznik, 6034483740, expires on 4/11/25. During file review, it was revealed that two staff (S1 and S2) were cleared, but they were not associated to the facility, LPA informed Licensee that both staff should never be working and providing care to residents prior to a criminal record clearance or exemption. Civil penalties are being assessed in the amount of $200 for allowing a person to work, reside or volunteer in the facility without a been associated to the facility. Medications and medication records were reviewed. A spot check of Medication and medication records was also conducted at 10:30am LPA/staff observed a loose tablet was found in the container of resident's (R1) medication. Administrator will review medication and their records and will conduct a staff training. Licensee provided the latest pharmacy audit dated December 2024. During today's visit, LPAs followed up on an incident report submitted to CCL notifying that resident (R3) on 12/30/24 around 1:11am was threatening to call the police on staff, pushing call button non stop, every time staff would answer their calls, R3 pretended that they were sleeping until 5am. R3 called the paramedics, when they arrived it was observed R1 being aggressive, throwing things at staff and paramedics took R3 on 5150. The facility notified R3's responsible parties. According to the Administrator, R3 is currently in the hospital receiving treatment and after their evaluation, it was determined that R3 needs to be relocated in a higher level of care. They are currently working on adequate placement for the resident's care needs to be met. Licensee/Administrator to submit updates of the following documents by 1/24/25: Designation of Administrative Resposibility (LIC308) & Liability Insurance Certificate. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with Licensee and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 14, 2025

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: -Facility is not following resident's special diet.

Licensing Program Analyst Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Licensee German Sinitsyn. The Department received an allegation of facility is not following resident’s special diet. Per Reporting party, staff report to Licensee that an unknown resident had a recent modification of diet texture (puree) due to potential choking incident, which was then disregarded by the licensee, who permitted staff to provide the resident with a food outside of their diet texture recommendation/order. In addition, there has been a lack of follow-through with diet texture recommendations and education to staff regarding safe and unsafe foods for resident (R1) and another resident (name unknown) where staff have expressed that they "use their best judgement", thereover putting the residents at risk of aspiration, choking, and/or death by not supervising residents during their mealtimes. Continued on LIC9099C... Unsubstantiated Continued from LIC9099... During the course of investigation, LPA conducted 10-day visit on 10/17/24, made observations and conducted interviews. Based on observations, there was a menu posted on the wall with food options, there were signs including high aspiration risk foods to avoid (rice, bread, baked goods, corn, hot dogs, sausages, all raw fruits/vegetables, dry and tough meats needed to be soft, cut into ¼” pieces with added moisture, etc. Foods allowed for mechanical soft diets, also known as “diced” or “chopped”. Reminders of food allergy with names of residents, four groups of staff assigned to assist residents during morning and afternoon meals. Based on records review of resident’s physician reports 10 out of 21 residents do have special diets on file. Resident’s (R1) initial prescribed diet texture dated 9/25/24 recommends as Puree, soft, bite-sized, nectar thick liquids; but according to the reporting party the facility provided R1 with regular solids and thin liquids. Then, R1’s diet texture was re-assessed on 9/26/24 and they were upgraded and recommended mechanical soft solids, nectar thick liquids. Staff training records indicates that staff have received required training hours regarding food management including assistance with feeding the residents. The facility provided LPA with the last four weeks’ menu served to residents, which appears to be appropriate for residents with special diet orders. Based on confidential interviews conducted with witness, staff, and residents. LPA have contacted the reporting party on 10/16/24, who confirmed their concerns regarding staff not following resident’s special diet due to a lack of training or education regarding caring for individuals with swallowing disorders and not adhering to recommendations for modified diet textures and liquid consistencies. According to the reporting party, the licensee refused training about food preparation of mechanically altered solids and thickened liquids offered by an outside agency due to their impression that food options and management is perceived as adequate for residents in care. Per staff (S1, S2, S3, S4, S5 & S6) they are informed by their supervisors when a resident’s diet has changes, also they do review signs posted on the kitchen’s wall instructing them about resident’s orders, allergies and assistance needed with their food. According to staff, residents are being offered with different food options to meet their preferences, their weekly menus are rotated every week, and staff did not recall any incident where a resident have chocked due to been provided with the wrong meal option. Interviews conducted with residents (R1, R2, R3, R4, R5 & R6) did not reveal any concerns, challenges or incidents with the food service provided by the facility. A finding that the complaint allegation occurs of facility is not following resident’s special diet is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Dec 17, 2024 · control 21-AS-20241015114030

Type of visit: Required - 1 Year

Licensing Program Analyst, (LPA) Cuadra, arrived unannounced to conduct an Annual Required Inspection and met with Erica Campos (Lead Staff). German Sinitsyn (Licensee) arrived later. One resident is receiving hospice services. Required postings were observed. Activity Calendars and Weekly Menus posted. LPA/Staff initiated a tour of the facility at 9:00 am and made the following observations: Facility was a comfortable temperature, well lit and passageways were free from obstructions. Residents were engaged in exercising activities during inspection. Resident rooms were furnished per regulation. Water temperature in bathrooms used by residents measured at 113.2, 105.1 and 106.2 degrees F which are all within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Closets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable and one week of non-perishable foods. Containers were labeled and covered per regulation. Medications were centrally stored and locked in the medication room. Fire extinguishers were last inspected December, 2023. Facility has a centralized smoke alarm and sprinkler system that is maintained by a vendor. The most recent inspection was conducted January 2024. Carbon monoxide detector was tested and operational. Exit doors have auditory alerts that were functional at time of visit. Each resident has a pendant to alert staff if the resident needs assistance. Last Disaster Drill was conducted on 10/11/23. Facility provides transportation to residents to their medical appointments. Continues on LIC809C... Continued from LIC809... File review was initiated at 10:00 am. 5 staff files and 10 resident files were reviewed. Staff have required First Aid and CPR certificates and annual continuation training hours were complete. 10 out of 10 residents' medical assessments and care Plans were updated/signed by a responsible party as required per regulation. Administrator Certificate for Licensee/Administrator Aida Reznik, 6034483740, expires on 4/11/25. Medications and medication records were reviewed. A spot check of Medication and medication records was also conducted at 11:00am LPA/Licensee found medication count discrepancies in at least 4 different medications (Acetaminophen 500mg, Hydrocodone 5-325mg, Docusate SOD 250mg and Amlodipine 2.5mg) checked for resident (R6 & R10). Licensee stated that they have not had a pharmacy audit at least twice a year, LPA will issue a technical violation. Licensee/Administrator to submit updates of the following documents by 1/19/24: Designation of Administrative Resposibility (LIC308), Personnel Report (LIC500) & Liability Insurance Certificate. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with Licensee and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 9, 2024

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.

Allegation investigated: -Facility did not seek timely medical attention. -Staff did not properly report an incident involving a resident.

Licensing Program Analyst (LPA) Cuadra arrived unannounced at the facility and met with staff Erica Campos to deliver findings regarding the complaint allegation above. Licensee Aida Reznik was not able to come to the facility, but was available by phone and gave authorization for staff to sign the report. There was an allegation of facility did not seek timely medical attention. Per Reporting Party, resident’s (R1) sock with blood was observed by a witness, it was surprising that facility staff who assisted resident with daily activities did not discover the sore of considerable size and depth on their right foot sock. During this investigation, The Department investigator conducted interviews with staff and other witnesses, reviewed records associated to the involved R1. Based on interviews conducted and records obtained, the investigation revealed that on 7/29/23, the pressure ulcer on R1’s right heel was noticed by a witness. According to home health records, R1 received skilled nursing care from 5/4/23 through 8/9/23; Prior home health visits on 7/29/23 did not uncover a pressure ulcer. Continued on LIC9099C... Substantiated Continues from LIC9099... Based on medical records dated 7/29/23 at 3:48:46pm responsible party contacted home health, which is indicated in the report that facility was aware of pressure injury. However, the facility did not seek timely medical from 7/29/23 until 8/7/23 when R1 met with their primary care physician through a virtual appointment and was diagnosed with a stage 2 pressure ulcer on their right heel. On 08/09/2023, R1 was assessed by hospice care staff and was diagnosed with a stage 2 pressure ulcer on their right heel. The Department obtained R1’s care plan dated 5/3/23 indicating that R1 needs assistance with daily activities including toileting, showering, and dressing. LPA conducted interviews with staff who informed LPA that they verbally notified responsible parties including home health agency about the blister that popped up from R1’s foot supposedly due to their socks that were assumed that were too tight. Facility failed to seek medical treatment when they noticed that the blister popped up to stage 2 pressure injury. Based on the information obtained by the Department during this investigation and confidential interviews conducted with witnesses, staff did not contact R1’s physician to seek timely medical attention after concerns about R1’s pressure injury. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. The Health and Safety Code is cited on the attached LIC 9099D. Appeal Rights Given. Failure to seek medical care resulted in violation causing injury to person in care $500 immediate civil penalty issued. The Department will be reviewing to determine if additional civil penalties are wanted. Regarding allegation about staff did not properly report an incident involving a resident. Per reporting party, staff did not notify R1’s responsible parties including the Department about R1’s pressure injury. Based on records review, LPA reviewed incident report logs for this facility, and it was determined that incident reports were not submitted to CCL. Administrator could not provide proof that incidents were reported to CCL. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. The Health and Safety Code is cited on the attached LIC 9099D. Appeal Rights Given. Continued from LIC9099A... LPA conducted interviews with staff who informed LPA that they noticed the blister that popped up from R1’s foot supposedly due to their socks that were probably too tight. Based on the information obtained by the Department during this investigation, facility staff were assisting R1 and there were no concerns raised regarding R1’s sustaining a pressure injury due to neglect of facility staff. Based on LPA’s confidential interviews conducted with witnesses, there is no supporting evidence to prove that staff neglect resulted in a resident sustaining a pressure injury. A finding that the complaint allegations staff neglect resulted in a resident sustaining a pressure injury is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Regarding allegation of staff was sleeping during hours of care and supervision. Per reporting party, on one occasion facility staff was observed asleep while R1 was watching the TV in bed. Based on Records review of facility schedule for the month of August 2023 indicates that caregivers who previously worked night shift will stay later in the morning to assist R1 with their care needs. On 11/9/23 LPA conducted interviews with facility staff and residents in care. Interviews revealed that R1 was receiving a higher level of care due to their aggressive and combative behavior, resuming services to one-on-one care. The caregiver who was their main companion will call another caregiver to help them to assist R1 with daily activities such toileting, showering, etc. However, there is no indication or supporting evidence that at any given time any facility staff was observed sleeping during business hours. A finding that the complaint allegation staff was sleeping during hours of care and supervision is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Another allegation is about staff is unable to communicate effectively. Per reporting party, the occasion when they observed staff sleeping during business hours, they attempted to talk to the caregiver, but the caregiver did not speak English. On 11/9/23 LPA conducted interviews with facility staff and residents in care. Per Administrator, staff are divided into groups of residents that will assist with care and supervision. Staff performances are based on family input of staff personalities. Administrator told LPA that there had been incidents where caregivers don’t communicate properly using the English level necessary to communicate with residents, then they will re-assign them to a different section. LPA was able to determine through interviews with facility staff and residents in care, that staff are able to communicate effectively in English when assisting residents in care. A finding that the complaint allegation staff is unable to communicate effectively is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Dec 12, 2023 · control 21-AS-20230905113442

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Dec 13, 2023

87466 Observation of the Resident - The licensee shall ensure that residents are regularly observed for changes in physical…& that appropriate assistance is provided when such observation reveals unmet needs...This requirement has not been met as evidence by: Based on interviews conducted and records review. Facility did not observe change of condition in R1 after blister popped out of R1’s right foot, which poses an immediate risk to the health and safety of the residents in care.the state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: Administrator/Licensee agrees to submit a written plan in how staff will assess resident’s pressure injuries after a change of condition by POC due date. $500 immediate civil penalty

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(B) · Plan of correction due date: Dec 13, 2023

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require… (1) A written report shall be submitted to the licensing...& person responsible for the resident within 7 days…(B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement has not been met as evidence by: Based on LPA’s records review and interviews conducted Administrator did not ensure that CCL was notified of incidents involving R1’s Stage II pressure injury, which poses a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: The Licensee will ensure all incidents that threaten the safety of residents are reported to CCL per regulation. Administrator to review regulation, conduct staff training on reporting requirements. Signed statement that the regulation was reviewed and sign in sheet for all staff trained to be submitted by POC due date.