Facility Evaluation Report

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced CASE MANAGEMENT visit to this facility in conjunction with a complaint. The purpose of this Case Management visit is to issue citations for deficiencies discovered during the course of the complaint investigation that is not directly related to the complaint allegation. During today’s visit, LPA spoke with Staff / caregiver Iuliia Palchikova who called the Administrator to inform them of the visit. The Administrator was unable to attend and designated staff Iuliia Palchikova to sign the report. LPA explained the reason for the visit.

During interview with Staff #1 (S1) revealed that sometime time early in June 2025 the exact date is unknown the facility was over capacity and had seven (7) residents. LPA observed the facility license which state that the facility’s total capacity is six (6). Facility does not have fire clearance for more than six (6) clients. File review conducted at 10:42 a.m. revealed that all six (6) current residents residing at the facility had an admission date prior to June 2025. Interview with S1 revealed that Resident #1 (R1) was brought to the facility sometime early in June 2025 the exact date is unknown via transportation service from Kaiser. S1 noted that they were unaware why the resident was brough to the facility as they were at full capacity with six (6) residents however still allowed the resident to stay which poses / posed an immediate health, safety or personal rights risk to persons in care. LPA discussed section Title 22 section 87202 Fire Clearance, 87204 Limitations - Capacity and Ambulatory Status and the importance of not operating a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time.