Routine inspection·July 10, 2024

Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced 1-year required visit on 7/10/2024 at 2:15pm. LPA met and toured with Caregiver, Elizabeth Zamora. LPA spoke with Administrator, Ali Dastgheib over the phone. The Administrator currently holds a certificate (#6046284740) that expires on 1/24/2025. The facility’s fire clearance was approved for 5 non-ambulatory and 1 bedridden. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 110.2 degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for clients. There is a minimum of 7-day non-perishables and 2-day perishables foods. Smoke detectors and carbon monoxide were not in operating condition during visit. Fire extinguisher was last serviced on 6/30/2023. Emergency Disaster Plan was last posted on 07/12/2021. First aid kit was observed to be complete. LPA reviewed 3 staff record files. 3 of 3 staff files were incomplete . LPA reviewed 4 clients' files and were found to be incomplete. Report continues on 809C. CONTINUE FROM LIC 809 LPAs observed the following deficiencies: - at 3:10 PM. LPA observed fire extinguisher expired (6/30/2023). - at 3:20 PM. LPA observed smoke detector/carbon monoxide was not working. - at 3:40 PM. LPA observed there is no Administrator file located at the facility. - at 3:50 PM. LPA observed 2 of 3 staff files incomplete. - at 4:20 PM, LPA observed there is no record of the last fire drill conducted. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. The following forms to be updated and submitted to CCL by 07/19/2024: LIC 500 Personnel Report LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 610E Emergency Disaster Plan Exit interview conducted. Appeal Rights and a copy of this report provided.