Routine inspection·February 20, 2025

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation. LPA was greeted and granted entry by Administrator (Admin) Malihe Fakhfouri and explained the reason for the visit. Administrator Fakhfouri had a valid certificate expired on July 3, 2024. LPA reviewed the certificate of completion and all course work were completed on April 30 and May 1, 2024. The facility is a single story structure located in a residential neighborhood. Facility is licensed to operate for six bedridden residents and maintains a hospice waiver for two residents. There are two residents in care and the Admin on duty. There are five resident bedrooms and three resident bathrooms. There is one additional private bedroom and bathroom for the live-in Admin. All common areas were inspected including the the attached two car garage. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for each residents' personal belongings were observed. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 106.7, 105.2, and 105.2 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available. The fireplace was screened. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The exit gates were self-closing and self-latching. LPA observed sufficient seating and shading. The three fire extinguishers were purchased on February 5, 2025 per the purchase receipt. The auditory devices and dual functioning smoke/carbon monoxide detectors were tested and operational. LPA observed sufficient emergency food/water in the outdoor walk-in pantry room. Emergency evacuation drills are not conducted quarterly with the last drill on August 28, 2024. The first aid kit contains all necessary elements. The facility land line number, (714) 668-5607, was tested and remains available. The liability insurance is valid expiring on October 30, 2025. LPA observed the required 'See Something, Say Something' (PUB 475) posters in the incorrect size of 11" x 16." The following items were addressed: discussed the importance of conducting and maintaining records of the quarterly disaster drills, to complete the current Emergency Disaster Plan (LIC610E) updated on (3/19), organize all personnel/resident records, to increase the PUB 475 poster in the size of 20" x 26," and to ensure annual fees in the amount of $495.00 is paid timely due March 17, 2025. Based on the observations made during today's visit, a deficiency is being cited. Advisory Notes (LIC9102s) are also being issued. An exit interview was conducted with Administrator Malihe Fakhfouri, and a copy of this report (LIC809/LIC809-C), LIC809-D, LIC9102s, appeal rights, and a copy of the LIC610E were provided at the end of the visit.