Routine inspection·April 25, 2024

Licensing Program Analyst (LPA) Tao conducted an unannounced required annual visit. LPA met with Administrator, Gladys Pervez, who assisted with the visit. The facility serves six (6) non-ambulatory elderly residents of which one (1) may be bedridden, ages 60 and above. Facility is approved for five (5) hospice residents. Facility fees are current. Administrator certificate is current with expiration date is 02/08/25. During the visit, CARE tool was used, a tour of the facility was conducted, food supply was reviewed, staff/residents were interviewed, files were reviewed, and medications were reviewed. The facility is a single family house located in a residential neighborhood; consisted of a living room, office, laundry room, dining room, kitchen, five (5) resident rooms, two (2) common bathrooms, front yard and backyard. Residents' rooms are furnished with appropriate furniture for residents’ comfort. The bathrooms are furnished with grab bars and nonskid surfaces. Adequate linen and personal hygiene supplies are observed. Common areas are observed for the ability to safely serve the needs of the residents. Smoke detectors and carbon monoxide detector are tested and operational. Fire extinguishers are fully charged. Facility maintains a comfortable temperature for residents. Auditory alarm devices to monitor exits are operable. Sufficient supply of perishable and nonperishable foods is observed. Hot water temperature is measured at 119.5 degrees Fahrenheit which is within Title 22 Regulation guidelines. Fire drill was conducted on 03/15/24. Medication are centrally stored in a locked storage room and inaccessible to residents. Resident records are stored in a locked storage room and inaccessible to residents. No deficiencies were observed per California Code of Regulations, Title 22. An exit interview was conducted. This report was discussed with Administrator, Gladys Pervez, who’s signature on this form confirm receipt of these documents. A copy of LIC 809 report was provided.