Routine inspection·June 6, 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 caregiving staff after introducing himself and stating the purpose of the visit. Administrator Rozina Amlani was notified of the visit via telephone and arrived later to assist. There are currently six residents in care, three 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. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with an attached garage. The facility has four private and one shared bedrooms along with one locked staff room. There are two bathrooms on the premises. Bedrooms appear clean and sanitary. Two residents are observed using full-length rails as postural supports along with two residents with half rails. Physician orders and hospice plans of care reviewed. 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 109F and 111F in two separate bathrooms equipped with faucets used for personal grooming. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage are verified to be secured. Fire extinguishers present are charged with up-to-date maintenance. Smoke and carbon monoxide detectors were found to be operational. CONTINUED ON FORM LIC809-C CONTINUED FROM LIC809 The garage is secured with a digital lock and used for laundry as well as additional storage of supplies. Emergency food and water supplies verified to be present. LPA and facility staff toured the outside of the facility. LPA observed a shaded outdoor seating area with furniture for resident use. The identified route of egress is 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. Oxygen is currently in use on the premises with adequate signs observed. There are no residents currently assessed as being bedridden at the time of the visit. Resident interviews were conducted or attempted during the visit along with staff interviews. LPA reviewed staff records for three staff members present during the visit. CPR training, initial and annual training reviewed. Disaster drills are conducted quarterly and documented. Staff members are verified to be background cleared and associated to the licensed location. Based on the observations made during today’s visit, no 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 weas provided to a facility representative.