Routine inspection·May 20, 2025

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility administrator Shahin Mokhtazad after stating the purpose of the visit. There are currently six residents in care, two of which are receiving hospice care at this time. LPA observed residents relaxing in the facility's common living areas or in their respective bedrooms. Two residents are away in the community also. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with an attached garage. The facility has six private bedrooms along with two staff rooms. Bedrooms appear clean and sanitary. Some of the residents are using half rails or full rails for postural supports. Physician orders requested during the visit and faxed by the hospice provider. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are equipped with grab bars and slip mats. Hot water temperature measured at 117F in two separate bathrooms.. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items and the medication central storage are verified to be secured. Cleaning supplies and supplements are observed to be stored without being secured. Type B citation issued. The two wall-mounted fire extinguishers are charged, with up-to-date maintenance tags attached. LPA tested the smoke and carbon monoxide detectors which were found to be operational. The garage is inaccessible to residents and used for laundry as well as additional storage of food and supplies. CONTINUED ON FORM LIC809-C CONTINUED FROM LIC809 LPA and facility staff toured the outside of the facility. LPA observed an shaded outdoor seating area with furniture for resident use. There are self-latching gates on both sides of the property and the routes of egress are free of clutter and obstructions. There are no bodies of water on the premises. Facility does not utilize locked perimeters or delayed egress. LPA reviewed six resident records which included all necessary components. LPA reviewed resident medication records and prescription orders for all residents with no discrepancies observed. Medication is however being pre-poured by staff for multiple days at a time. Type B citation issued. Oxygen is currently in use with adequate signs posted. There is one resident currently assessed as being bedridden at the time of the visit while another non-ambulatory resident still shows as bedridden on their physician report even though they are witnessed having lunch in a wheelchair in the dining room. Consultation provided on the need to update the resident's assessment to reflect changes in condition. Resident interviews were conducted or attempted during the visit along with staff interviews. LPA reviewed staff records for two caregivers present during the visit. Present staff members have current CPR certificates on file. Annual training on file. Disaster drills are conducted three times a year with proof of attendance provided. Consultation provided. Both staff members present are background cleared and associated to the licensed location. Based on the observations made during today’s visit, two type B deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.