Routine inspection·February 13, 2025

At approximately 9:00AM , Licensing Program Analysts (LPAs) Magdaleno and Felias arrived unannounced to conduct a required 1-year annual inspection and were greeted by Administrator , Pari Manouchehri. Facility provides care and assistance to Older Adults in Assisted Living and Memory Care. Facility has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance for a total capacity of 126 individuals, where 126 individuals can be Non-Ambulatory and 8 individuals can be Bedridden. Facility has an approved hospice waiver for 15 individuals. Upon arrival, LPAs were informed that there were 74 residents in care and 19 staff members on-site. At approximately 9:50am , LPAs initiated a tour of the facility with Administrator and observed the following: Facility is a three story facility, was at a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected April 2024 and are charged . Smoke and Carbon Monoxide are hardwired with sprinkler system, last serviced 1/22/25 by vendor. A sample of facility sink temperatures were taken and included 14 resident rooms and 1 memory care kitchen sink. LPAs observed that 4 sinks were shown to be out of compliance with Title 22 regulations. LPAs observed a supply of clean linens, hygiene care, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPAs observed at least a 2-day supply of perishable and 7-day supply of non-perishable food, as well as emergency food stores with a 10 year shelf life. Food was found to be stored in a safe manner with open items covered, as well as an emergency water supply. LPAs observed a piano, bookshelves full of books, puzzles, and LPAs were informed that the facility plays table tennis, takes trips to the local farmers market, has trivia nights, and conducts daily exercises. At approximately 12:30pm, LPAs conducted review of 6 staff records. All required documentation present. Pari Manouchehri Administrator Certificate 7003752740 expires 3/24/26. All fees are current as of this time. LPAs and Administrator discussed facility's Emergency Disaster plan, No new updates. Facility’s last quarterly disaster drill was conducted on 12/2/24, with the next one scheduled end of February 2025. Continued on 809C... Continued from 809... LPAs followed up on an incident report that was submitted to Community Care Licensing (CCL) on 02/11/2025. Death Report 1 : CCL received a death report on 02/11/2025. Per report, on 02/09/2025, Resident 1 (R1) was found unresponsive by facility staff. Facility staff contacted emergency personnel for further evaluation. Facility made all appropriate notifications per regulation. LPAs requested and obtained additional documentation. LPAs also requested for additional paperwork for Change of Administrator. LPAs requested the following for Pari : First Aid/CPR certificate copy of current driver's license copy of active/current administrator's certificate copy of board of directors' resolution meeting minutes signed (required for all corporations) Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: Liability Insurance LIC500- Personnel Report LIC308- Designation of Responsibility LIC610E-Emergency Disaster Plan LPAs unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date. No Deficiencies cited during visit. Exit interview conducted with Administrator and a copy of this report was given.