Routine inspection·June 18, 2024

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1 Year Inspection using the Care Inspection Tool. LPA Cho was greeted and granted entry by Administrator (Admin) Arya Maghbouleh and explained the reason for the visit. The facility is a single story structure located in a residential neighborhood. Facility is licensed to operate for six (6) non-ambulatory of which all may be bedridden and maintains a hospice waiver for six (6). There are three (3) residents under hospice and one (1) bedridden resident during today's visit. LPA toured the interior and exterior portions of the facility. There are a total of five resident bedrooms and two resident bathrooms. There are two staff bedrooms. LPA observed the facility to be clean and sanitary. The resident rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke/carbon monoxide detectors and auditory exit alarms were tested and operational. LPA observed bathrooms to be in good repair, provided with handrails, and a non-skid floor mat. The hot water temperature measured at 117.3 and 115.5 degrees Fahrenheit in the resident bathrooms. Facility met the two day perishable and seven day non-perishable food supplies. LPA observed medications, toxins, and sharps were inaccessible to the residents. The three fire extinguishers were purchased on today's date. LPA observed clutter in the garage which is a safety hazard. For the exterior portion, facility had sufficient seating and shading. The exit doors were self-closing and self-latching. LPA observed the emergency disaster supplies including food/water. LPA observed the required "See Something, Say Something' (PUB475) poster in the required size. Administrator's Certificate for Kathy Maghbouleh expires on 12/06/24. LPA conducted an audit of six residents' files and two staff files. No discrepancies noted however please ensure that the health screening for the staff is completed by June 22, 2024. Staff and resident interviews were conducted. Medications were audited. No discrepancies noted. LPA consulted the following: to clear the clutter in the garage in order to adhere to the regulations by the State Fire Marshal, to obtain a medical assessment and Tuberculosis test results using the Physician's Reports (LIC602s), to ensure a medical assessment including the health screening is completed for an employee, to obtain doctor's orders for the full bed rails, and to conduct and maintain a log for the earthquake drills. Based on the observations made during today's visit, deficiencies are being cited as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. See the attached LIC90999Ds. A Technical Violation is being issued today. See the attached LIC9102. An exit interview was conducted with Administrator Arya Maghbouleh, and a copy of this report including the LIC809C, LIC809Ds, LIC9102, LIC811s, and the appeal rights were provided during this visit.