Velori Senior Living

Type of visit: Required - 1 Year

Licensing Program Manager (LPM) Mary Flores and Licensing Program Analysts (LPA), Leslie Ngo-Castaneda conducted an unannounced required 1-year inspection at this facility at approximately. LPA were greeted by staff, Dmytro Dovgenko and Iryna Dovgenko and was explained the reason for the visit. At 2:09 PM the administrator, Karina Gevorkian, arrived and was disclosed the purpose of the visit. At 2:30 PM licensee arrived, Iryna Raskopina, arrived and was disclosed the purpose of the visit LPA conducted a tour of the physical plant at approximately 2:10 PM to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Common areas were observed for the ability to safely serve the needs residents. These included the kitchen, dining room area and living room. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately. LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the six (6) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen vegetables. Sharps are stored in locked kitchen cabinet. The resident medications are locked in office cabinets by the office. The medications were observed to be inaccessible to residents. There is one (1) fire extinguishes located in the kitchen. Fire extinguishers observed to be charged at 9.23.2025. Laundry room is beside the kitchen. The appliances observed to be functional. Due to time constraints this required annual will be completed at a later time. Exit interview conducted/Copy of report giventhe state’s words, verbatim · CDSS document, Apr 8, 2026

Type of visit: Required - 1 Year

On 4/25/25 at approximately 9:25am, an unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena Khurshudyan. Upon arrival, LPA met with the Caregiver Sofia Raskopina, who granted access to the facility. LPA introduced herself by showing her department badge and explained the reason for the visit. Shortly after the Administrator, Rena Danielyan arrived and helped with documents. During today's visit, LPA conducted a physical plant walk through, at approximately 9:50am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22. The following was observed: The facility is a single-story home and is licensed for capacity of six (6) residents, of which six (6) may be Non-Ambulatory, Bedroom #3 is approved for Bedridden. Facility also has hospice waiver for six (6) residents. There are six (6) bedrooms, of which five (5) bedrooms are designated for residents’ use and one (1) bedroom is designated for staff use only. All bedrooms observed to be appropriately furnished and have appropriate lighting. There are four (4) bathrooms in the facility of which three (3) are designated for residents’ use and one (1) for staff use. LPA observed bathrooms have soap, paper towels and hand washing signs. The hot water temperature measured at 10:25am to be 108.7°F. Extra towels and linens were readily available in the linen closet located in the hallway. There are grab bars for each toilet and shower, bathrooms have non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination. LPA observed facility alarms were present on all exit doors and all of the signals were functional. SMOKE DETECTORS/CARBON MONOXIDE. The smoke detectors and carbon monoxide are hard wired, inter-connected and were located throughout the facility. At 11:15am they were tested and observed to be operational. The facility has one (1) fire extinguisher that was last purchased on 3/5/2025. Continue on LIC809-C KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven, dish washer and sink. The kitchen appliances and fixtures were functional. LPA observed the kitchen area, there was sufficient stock of one week non-perishable foods and two days of perishable foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. LPA observed that sharp objects were stored inside the kitchen cabinet, which was observed to be locked and inaccessible to residents in care. Extra emergency food was properly stored inside the pantry room across from laundry area. The common areas which include dining and living room appeared clean and were properly furnished. Temperature was comfortable it was measured at 11:15am to be 70°F. No obstructions and or tripping hazards throughout the facility found. MEDICATION: LPA observed medications are centrally stored and locked inside the commercial cabinet located in the staff room. First Aid kit was also available and was checked by the LPA to be complete with the new manual available with it. Facility operated with two (2) shifts and has two (2) staff for AM shift and one (1) awake caregiver for PM shift. COMMON AREAS: LPA observed living room and a dining room that appeared generally clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Facility has land line; LPA checked its operational. LAUNDRY ROOM: Laundry machines are located by the kitchen area and observed to be operational. LPA observed chemicals and detergents were stored and locked inside the cabinet located above the laundry machines. LPA discussed the importance of keeping potentially dangerous items locked at all times. SURROUNDING GROUNDS: LPA observed sufficient yard space with fenced backyard. Appropriate outdoor furniture, with covered shaded area available for residents to rest and enjoy outside weather. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. Exit doors were unlocked and free of obstructions. The facility does not have a swimming pool or body of water. There is no garage in the property. FILE REVIEW: Between 11:25am to 12:40pm, LPA reviewed records and files of three (3) residents and three (3) staff/caregivers. A review of staff and resident records appeared to be complete. Resident’s files contain signed admission agreements and a medical assessment, and all other required documents/forms. Continue on LIC809-C A review of staff records indicates that all facility staff and who required caregiver background checks have received criminal record clearances. There are no residents with prohibited conditions residing at the facility. Facility provides activities to the residents in care, activity games, books, board games were nicely stored and available in the living room. An emergency exit plan/sketch along with other posting requirements are posted on the wall by the entrance area. Medications Review: At approximately 12:45pm. LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. Facility also maintains Medical Administration Records (MAR). PRN medications have written orders from a physician. Potentially dangerous items are kept inaccessible to residents in care. LPA collected LIC500, LIC9020, copy of Liability Insurance Certificate, and Administrator certificate. No citation issued during today’s visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Apr 25, 2025

Allegation investigated: . Facility is unkept 2. Staff changed resident's financial information without prior authorization

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an initial complaint visit to investigate the allegations mentioned above. LPA was greeted by caregiver Dilya Zhanisakova, who was informed the reason of the visit. Caregiver contacted Licensee Irina Raskopiana, who LPA spoke to over the phone and was also informed of the visit. Licensee arrived shortly after. The following was determined: Allegation # 1: It is as alleged facility is unkept. During today’s visit, from 1030am to 3pm, LPA conducted interviews, a physical plant inspection and reviewed resident records. LPA observed all common areas, the living, dining, kitchen, resident rooms, and bathroom, to be clean and appropriately furnished for resident’s comfort. Therefore, based on observations, the allegation is Unsubstantiated. Allegation # 2: It was alleged staff changed resident’s financial information without prior authorization. During today’s visit, from 1030am to 3pm, LPA conducted interviews, a physical plant inspection and reviewed resident records. LPA interviewed R1, who revealed to LPA, that R1 wanted copies of bank statements so Unsubstantiated that R1 could withdraw money and get the balance of R1’s account. Staff did contact the power of attorney to inform R1’s request. Although the POA denied the request and staff did not take R1 to the bank. R1 walked to the bank and obtained copies of the bank statements and withdrew money without assistance. As R1 was returning to the facility, staff observed R1 walking and gave R1 a ride. Therefore, based on interviews, the allegation is Unsubstantiated at this time. Exit interview and copy of report provided.the state’s words, verbatim · CDSS document, May 23, 2024 · control 31-AS-20240517163642

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Tuesday Cabiness conducted a case management, in conjunction with complaint control # 31-AS-20240517163642. During the initial visit, LPA identified (2) staff that were not finger print cleared, nor was associated with the facility. Civil penalties will be assess during the visit. This is an immediate health and safety risk to residents in care. Also during the investigation, and reviewing resident records and staff files, LPA observed both staff did not have a personnel file at the facility and Licensing required documents were not available to be reviewed. The following items were missing: 1st Aid/CPR certificate Fingerprint clearance and association to the facility LIC501 – Personnel application LIC503 – Health Screening LIC508 – Criminal Record Statement LIC9052 – Employee rights TB Test LIC198 – Child Abuse Index form LPA informed Licensee that all documents must be submitted by the POC date. Exit interview, appeal rights, copy of report provided.the state’s words, verbatim · CDSS document, May 23, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(b) · Plan of correction due date: May 24, 2024

Criminal Record Clearance: (b) Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption. This requirement was not met, evidenced by, during today's complaint visit, LPA reviewed the personnel summary for (2) staff that were at the facilty and they did not have a fingerprint clearance. This is an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 23, 2024

Plan of correction: Licensee has AGREED to submit to LPA by 5pm on 05/24/2024, completed applications to start the fingerprint clearance process. On 05/28/2024, both staff will get fingerprint cleared and submit proof to LPA via email.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(a) · Plan of correction due date: Jun 10, 2024

Personnel Records: (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement was not met, evidenced by, based on file review during today's visit LPA observed (2) staff with no personnel record or file at the facility. All Licensing required documents were missing. This is an potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 23, 2024

Plan of correction: Licensee has AGREED to compile all Licensing required documents for staff and create personnel files for the (2) staff that were missing documents during today's visit. All documents must be submitted by POC date.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Abeye Duguma conducted an announced Pre-licensing visit at around 11:15 AM and met with the Licensee, Irena Raskopina. LPA conducted an entrance interview with the Licensee. LPA Duguma also observed that there were six (06) residents in the facility during the inspection. All residents appear to be clean and groomed. With the assistance of the Licensee, LPA conducted a facility tour of both the inside and outside. This is a single-story property. Fire Clearance is approved for six (06) non-ambulatory of which one (01) may be bedridden. Facility has five (05) bedrooms and three (03) full bathrooms for residents. One (01) out of five (05) bedrooms is semi-private and the remaining are all private single occupancy. All residents’ bedrooms were adequately furnished. The facility has a designated staff room/office with its own bathroom. Facility also has a half bath for visitors near the front entrance. Resident bathrooms have properly installed grab bars and shower has non-skid mats. The average hot water temperature measured at 115.5ºF during the visit. The common areas were appropriately furnished. The LPA observed entertainment equipment and games for activities. The staff office has a designated storage cabinet for resident and staff records. The first-aid kit is complete. The facility has adequate linen, water, and emergency kits. The linens were stored in the storage space located in the hallway. The facility has working egress alarms on all exits. Smoke detectors and carbon monoxide detectors were checked and function properly. There is a fully charged fire extinguisher located between the kitchen and dining area. (CONT on LIC 9099-C) Receipt shows that fire extinguishers were purchased on 02/15/2024 and LPA advised the Licensee to retain the receipt of the fire extinguisher identifying the purchase date to ensure the time frame for annual inspection. LPA Duguma observed a washer and dryer in the laundry area. All chemicals, additional personal hygiene items were stored in the locked cabinets. The medications are stored in a locked cabinet in the office. LPA inspected the kitchen and observed stove and refrigerator to be clean and working. Knives and sharps are stored in a locked kitchen drawer. There is sufficient outdoor space with seating and a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. At the time of this visit the physical plant is meeting Title 22 requirements. Component III was completed with the LPA. No health and safety hazard were noted during this visit. Exit interview was conducted and a copy of report was issued.the state’s words, verbatim · CDSS document, Apr 17, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Raskopina, Irina - Applicant and Danielyan, Rena - Administrator Interview Method: Virtual interview (Skype, Go To Meeting, etc) On 03/14/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Mar 14, 2024