Pre-licensing visit·October 20, 2025

Licensing Program Analyst (LPA) Daniel Konishi made an announced visit and met with the Applicant, Hanna Seidfathi to conduct an announced Pre-Licensing evaluation. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: An application was submitted to Community Care Licensing Department (CCLD) for an initial application of a Residential Care Facilities for the Elderly (RCFE) to serve adults ages 60 and over. Approved for six (6) non-ambulatory residents of which one (1) may be bedridden in bedroom #1. Waiver/granted for hospice care for six (6). Structure: Facility is a single-story home located in a residential area consisting of four (4) bedrooms, two (2) bathrooms, kitchen, dining room, living room, garage, and a backyard with seating and shade. Front entry and all exits have a wheelchair ramp. Operational Requirements: The facility did not have proof of liability insurance during today's visit and that they were instructed to obtain the liability insurance prior to accepting the first resident and will submit proof of that insurance to the department once it is obtained. Bedroom Clients: Bedrooms are equipped with a bed, nightstand, chair, lamp, dresser, trash bins, and overhead lighting. Bathrooms: two (2) full bath equipped with working toilet, wash basins, shower. Linens & Hygiene Supplies: All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linens is stored in linen closets. Emergency Phone Numbers, Exit Plan: Emergency numbers and Exit plans are posted and readily available for review. One (1) fully charged fire extinguishers was observed. Facility has a land line telephone. [Continue in LIC809-C] Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils were observed locked and inaccessible. Adequate food supply is stored in the kitchen and consists of the following: 2-day perishables, and 7-day non-perishables. Emergency water supply was observed. Carbon Monoxide/Smoke Detectors: Carbon Monoxide and Smoke Detectors were observed, tested, and working properly. Appliances: Refrigerator, oven, microwave, dishwasher and washer/dryer are in good condition. The residence is equipped with central heating and air conditioning. Toxins: Cleaning supplies, and toxins are locked only accessible to staff. Water Temperature: Hot water was tested in all bathrooms, and kitchen sink. Water temperature was within normal limits 105 degrees Fahrenheit and not more than 120 degrees Fahrenheit. Medication, First-Aid Kit & Book: Designated centrally stored medications cabinet, and the first-aid kit has been inspected which has at least the following: tweezers, scissors, antiseptic, bandages, gauze, thermometer; including a current First Aid manual. Resident & Staff Files: Designated area for files will be in a locked closet. Pools/Jacuzzi/Body of Water: No bodies of water were observed. Fire Clearance: Fire clearance was approved on 06/11/2025 for six (6) non-ambulatory residents of which one (1) may be bedridden in bedroom #1. Waiver/granted for hospice care for six (6). Component III: Component III was reviewed during inspection. Pre-Licensing is complete, and this facility has no deficiencies. Exit interview was conducted with the Applicant, Hanna Seidfathi and a copy of this report was provided.