Routine inspection·September 30, 2025

Licensing Program Analyst (LPA) Nadia Shahbazian met with Elizabeth Tiku for an Annual Required visit and inspection of the facility. LPA explained the reason for the visit. The facility is a one story home, located in a residential neighborhood and consists of five (05) bedrooms, of which one (01) bedroom is for staff, and three (03) bathrooms. This Residential Care for Elderly (RCFE) is approved for residents ages 60 and above. Facility is fire cleared for one (01) ambulatory, five (05) non-ambulatory residents, of which one (01) may be bedridden in room #3 and a hospice waiver for six (06) residents. Currently there is one (1) resident on hospice. At 12:15pm, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed in the dining room. The smoke/carbon monoxide detectors are hardwired and interconnected. At 12:30pm smoke/carbon monoxide detectors were posted and observed to function properly. The fire extinguisher is located in the kitchen with purchase date of 10/30/2024. Common Areas : These included the living room and dining room. The common areas were properly furnished with tables, chairs, sofas. There is a television set and a cabinet with games in the living room. There is a linen closet in the hallway, next to bedroom # 1. Facility provides internet and cable access . Kitchen: The kitchen appliances and fixtures were functional and consisted on stove, oven, refrigerator, microwave and dishwasher. Kitchen surfaces and appliances are clean and food is marked purchase or expiration dates. LPA found a sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility, with plenty of dishes in the cupboards. Knives and sharp objects were stored in a locked cabinet in the kitchen. (Continued on LIC 809-C) Bedrooms/Bathrooms: There were five (5) total bedrooms but bedroom #2 is currently used as office/staff bedroom. All of the bedrooms, in use by residents were were properly furnished with appropriate beddings, chairs, cabinets and sufficient lighting and linens. There are three (3) bathrooms designated for staff and residents' use. All bathrooms were properly supplied and had functional fixtures and required non-skid mats. Hot water temperature was measured between 114.1 and 122.4 degrees Fahrenheit. Surrounding Grounds : There are no bodies of water present. There are exit doors in bedrooms 3, 4, and 5, and in the kitchen, leading to the backyard. Facility uses the main door as the emergency exit but there is a side gate as emergency exit, as well. All walkways and exit passages were free of obstruction. There is patio furniture with an umbrella, appropriate for outdoor use. There is an attached garage, currently used as storage. LPA observed a refrigerator for staff use in the garage. There are locked cabinets for storage of chemicals and detergents, and a washer and dryer in the garage. There is a locked storage room and a locked shed in the backyard for storing items. Medications : Medication and Medication Records are kept locked in a kitchen cabinet. Medications for 2 out of 4 residents were counted and records were reviewed for accuracy of administration. LPA observed two first aid kits and a first aid manual in the medication cabinet. Resident Files : LPA conducted a file review of all 4 resident records to ensure compliance of licensing forms, including physician records, appraisal and needs and other required documents. Staff Files : LPA conducted a file review of staff records to ensure forms and training are up to date and compliant with licensing forms. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies observed during the visit. Citation and appeal rights were provided. Exit Interview Conducted / A Copy of the Report Issued.