Routine inspection·August 19, 2022

Licensing Program Analyst (LPAs) Evelin Rios and Michael Cava conducted an Annual Required visit and inspection of the facility. LPAs met with the administrator, Daisy Tajdari and explained the reason for the visit. At 9:15am, with the assistance of the administrator, LPAs took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are hardwired. There is a carbon monoxide detector located in the hallway that functions properly. The fire extinguisher is located in the kitchen. The charge date is 06/20/2022. The internal temperature is set at 80 degrees at the time of the visit. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Bedrooms: There were five (5) bedrooms. Four (4) are designated for the residents' use. The one room is for staff. The resident bedrooms in use were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 128 degrees Fahrenheit. Common Areas : These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Passageways and exits were clear of obstruction. Surrounding Grounds : Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. LPAs inspected a shed in the backyard and observed an additional supply of non-perishable canned food sufficient for seven days. There is another refrigerator at the outside with additional perishable food items. The laundry area and detergents is also located outside, on the side of the home. Resident Files : LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files : LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications : Medication and Medication Records were review for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued.