Routine inspection·August 15, 2024

On August 15, 2024, at 8:00am, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Assistant Administrator (AA) Hashim Moosani and explained the purpose of the visit. The facility is licensed to operate for four (4) ambulatory residents and two (2) non-ambulatory residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, one (1) Staff bedroom, two (2) bathrooms, living room, family area, dining room, kitchen, attached 3-car garage, swimming pool, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with AA Moosani. There are no obstructions on premises. There is a swimming pool located in the backyard that is enclosed with a fence which makes it inaccessible for the residents. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Staff Room 1 Bathrooms were found to be clean. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly Emergency food and emergency water is stored in the kitchen pantry. A working telephone (714-660-9268) remains available. First Aid Kit contained all the necessary elements. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). Evaluation Report Continues on LIC 809-C This page was amended due to technological error not having the Assistant Administrator Hashim Moosani digital signature. AA Moosani signed digitally but the final recorded original did not print with the signature. Due to time constraint a continuation of this inspection will be conducted at a later date. LPA Kim will: 1) conduct record review for staff and residents, 2) Conduct interviews with staff and residents, 3) conduct a medication review at a later date and 4) review fire/safety drill log. Deficiencies were cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6 Chapter 8). An exit interview was conducted and a copy of this report and the appeal rights were provided to Assistant Administrator Hashim Moosani