Routine inspection·May 10, 2024

Licensing Program Analysts (LPAs) Reyes and Tao conducted an unannounced annual licensing inspection. LPA Reyes explained the purpose of the visit to Administrator Gladys Pervez , This facility is a Residential Care for Elderly (RCFE) to serve residents for age 60 and above. The capacity is six (6). The licensee is Elite Manor Inc. Facility has a Dementia Care program for six (6) residents. Hospice waiver was approved for five (6). Administrator Gladys Pervez has an RCFE Certificate issued for 02/09/2023 with an expiration date of 02/08/2025. 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, laundry room, dining room, kitchen, five (3) resident rooms, two (2) 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 113.5 degrees Fahrenheit which is within Title 22 Regulation guidelines. Fire drill was conducted on 04/06/24. 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.