Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 2
Jul 21, 2025
Visit Reason
An unannounced annual inspection visit was conducted to evaluate compliance with licensing requirements and ensure the safety and well-being of residents.
Findings
The facility was generally clean and well-maintained with appropriate safety equipment in place; however, immediate health and safety risks were identified due to cleaning supplies stored below a resident bathroom sink and prescribed medications stored unlocked in the kitchen refrigerator. Additional documentation and updated forms were requested.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Cleaning solutions stored below resident bathroom sink, posing an immediate health and safety risk to residents. | Type A |
| Prescribed medications such as insulin and eye drops observed in an unlocked refrigerator in the main kitchen, posing an immediate health and safety risk to residents. | Type A |
Report Facts
Residents present: 6
Total capacity: 6
Staff present: 2
Water temperature: 115
Fire extinguisher inspection date: Apr 25, 2019
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alex Zitser | Administrator | Facility administrator met during inspection and named in report |
| Jaime Vado | Licensing Program Analyst | Conducted the inspection visit |
| Lee Collano | Caregiver | Met initially by Licensing Program Analyst during inspection |
| Marat Zitser | Administrator | Son of licensee and administrator of the facility |
| April Cowan | Licensing Program Manager | Named in report as licensing program manager |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 4
Jul 23, 2024
Visit Reason
An unannounced annual inspection visit was conducted to evaluate compliance with regulatory requirements and ensure resident safety and facility operation standards.
Findings
The inspection found the facility generally clean and well-maintained with proper storage of medications and food supplies. However, immediate health and safety risks were identified including excessively high water temperature (133F), lack of documented emergency/disaster drills for at least a year, cleaning supplies stored within reach of residents, and staff files lacking current first aid and CPR certifications.
Severity Breakdown
Type A: 4
Deficiencies (4)
| Description | Severity |
|---|---|
| Water temperature measured at 133F in a common resident bathroom, exceeding the maximum allowed temperature and posing an immediate health and safety risk. | Type A |
| No disaster drill log present and no disaster drill conducted for about a year, posing an immediate health and safety risk to residents and staff. | Type A |
| Cleaning supplies stored below resident bathroom sinks accessible to residents, posing an immediate health and safety risk. | Type A |
| No staff on duty have current first aid or CPR training on file, violating health and safety code requirements. | Type A |
Report Facts
Water temperature: 133
Census: 5
Total capacity: 6
Deficiency count: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alex Zitser | Administrator/Licensee | Met during inspection and named in interview regarding staff training deficiencies |
Inspection Report
Plan of Correction
Census: 3
Capacity: 6
Deficiencies: 1
Aug 11, 2021
Visit Reason
The visit was an unannounced plan of correction (POC) inspection to evaluate the facility's response to previous observations and citations made during the annual inspection on 7/26/21.
Findings
The inspection observed compliance with COVID-19 protocols such as temperature screening, symptom logs for residents, posted signage, and staff wearing face coverings. However, debris remained in the backyard and additional COVID signage was advised. Proof of payment for renewal of the RCFE administrator certification was submitted.
Deficiencies (1)
| Description |
|---|
| Debris in backyard that should be removed from premises |
Report Facts
Facility capacity: 6
Census: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alex Zitser | Administrator | Facility administrator involved in providing updates and certification renewal |
| Marisa Tadeo | Met with licensing program analyst during inspection |
Inspection Report
Follow-Up
Census: 3
Capacity: 6
Deficiencies: 2
Aug 11, 2021
Visit Reason
The visit was conducted as a Case Management - Deficiencies follow-up in response to information provided during the annual inspection on 07/26/2021 and observations made on 08/11/2021.
Findings
Two deficiencies were cited: (1) staff member R.S. lacked criminal record clearance and association with the facility, posing an immediate health and safety risk, resulting in a $100 civil penalty; (2) failure to report four clients with COVID-19 infection to CCLD in January 2021, which also posed an immediate health and safety risk.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Staff member R.S. providing care did not have criminal record clearance and association with the facility, posing an immediate health and safety risk. | Type A |
| Failure to report four clients with COVID-19 infection to CCLD in January 2021, posing an immediate health and safety risk. | Type B |
Report Facts
Civil penalty amount: 100
Number of clients with COVID infection not reported: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alex Zitser | Administrator | Facility administrator met during the visit |
| Julio Montes | Licensing Program Manager | Named as Licensing Program Manager overseeing the inspection |
| Audrey Jeung | Licensing Program Analyst | Licensing Program Analyst conducting the inspection |
Inspection Report
Annual Inspection
Census: 2
Capacity: 6
Deficiencies: 2
Jul 26, 2021
Visit Reason
The inspection was a required unannounced 1-year visit to evaluate the facility's compliance with regulations and licensing requirements.
Findings
The inspection found that the facility generally maintained adequate infection control, safety, and environmental conditions, but cited deficiencies related to a padlocked exit gate posing a safety risk and unpermitted alterations to the building including an additional bedroom, bathroom, elevator, and hallway.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Wood gate on side of house is padlocked from street side, posing an immediate health, safety or personal rights risk to persons in care as it is one of two exits to street from backyard. | Type A |
| Additional bedroom, bathroom, elevator and hallway added after initial licensure without obtaining building permits or city planning approval, posing a potential health, safety or personal rights risk. | Type B |
Report Facts
Facility Capacity: 6
Census: 2
Deficiencies Cited: 2
Plan of Correction Due Date: Jul 26, 2021
Plan of Correction Due Date: Aug 9, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alex Zitser | Administrator | Certified RCFE administrator overseeing facility operations |
| Audrey Jeung | Licensing Program Analyst | Conducted facility tour and inspection |
| Julio Montes | Licensing Program Manager | Supervising licensing official |
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