Routine inspection·May 6, 2025

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility today to conduct a required annual visit. The LPA met with Administrator/Operator Nirvana Ghaemi, and explained the reason for the visit. The LPA, and the Administrator toured the physical plant areas at approximately 10:40 a.m. inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Fire extinguisher last serviced 05/16/2024. BEDROOMS: The resident bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are three bedrooms for resident use; room#3 and room #4 are designated staff room. Rooms #1, #2, #5 and #6 are designated resident rooms. RESTROOMS: Residents’ restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Proper hygiene products and paper products are available for use. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable food and non-perishable food; knives, sharps observed stored in a locked cabinet drawer; clean supplies also observed locked under kitchen sink cabinet. The facility maintained a temperature of 75 degrees. All exits have functioning auditory devices. Required postings observed in the kitchen and hallway area. The backyard has a covered outdoor area equipped with furniture for resident use. The side gate door is self-latching. There were no bodies of water noted. The garage is detached from the home and kept locked. Laundry machine and detergents observed in the locked garage. (Continue to LIC809c). RESIDENTS' records review began at 11:30 a.m., records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. STAFF records review began at 12:45 p.m., records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 2:30 p.m. Medications are centrally stored and locked in a cabinet in staff room #4. Medications were labeled and checked for expiration dates. Medications are properly documented on the Centrally Stored Medication & Destruction Record (LIC 622)..Two residents’ medications were audited and found to be in order. All medications were logged, contained all required fields. Administrator did not have a PRN Authorization letter on file for resident #2 and resident #3. INFECTION CONTROL : Staff are following facility's infection control plan; maintaining cleanliness and disinfecting/sanitizing facility daily. . The LPA requested administrator to submit an updated LIC500 Personnel Report and current liability insurance be sent to CCL by 05/9/2025. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview was conducted. A copy of the report and appeal rights were provided.