Pre-licensing visit·July 23, 2021

Licensing Program Manager (LPM) Simon Jacob, and Licensing Program Analyst (LPA) Lizzette Tellez visited the facility to conduct a Pre-Licensing inspection. LPM and LPA identified themselves to Administrator, Itzel Guevara, and were allowed entry into the facility. LPM and LPA met with Ms. Guevara and discussed the purpose of the visit. Chief Executive Officer (CEO), Kourosh Shirazi, was present via videoconference. LPM and LPA, accompanied by Ms. Guevara, toured the physical plant. LPM, and LPA observed resident accommodations including furnishings, linens and personal hygiene items. The temperature of the hot water for use by residents was 107.8 F. Administrative, resident, and staff records were stored in a locked cabinet. Food service including dishes, utensils, food storage and a seven day supply of non-perishable food items are present. Toxic substances are stored in a locked office. Centrally stored medication and administration logs were located in a locked medication room. A first aid kit was located in the locked closet. Activities, supplies and sufficient space to conduct are present. Fire extinguishers are affixed with a current tag. Smoke and carbon monoxide detectors are present and operable. Facility posting requirements are present in a common area and the facility administrator's certification is current. There are no pools or bodies of water. Per Ms. Guevara, there are no weapons or ammunition located on the property. The Component III portion of the application process was completed with the Administrator and CEO. This application will be sent to the Centralized Applications Bureau (CAB) for final review and approval. The Applicant will then be notified of management approval by phone and the new license will be mailed to the Applicant. An exit interview was conducted with the Administrator , and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.