Routine inspection·April 2, 2025

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Caregiver John Moralida and explained the reason for the visit. Administrator (Admin) Maryam Alamoutinia arrived on premise to assist with the inspection. The facility is a single story structure and is licensed to operate for five non-ambulatory residents of which one may be bedridden and maintains a hospice approved for two. There are no residents on hospice during today's visit. During the tour of the physical plant, LPA observed six resident bedrooms and five resident bathrooms with one additional bedroom occupied by two staff. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational, however the hot water temperature measured at 137.8, 134.7, 133.1, 135.6, and 129.2 degrees Fahrenheit. All common areas were inspected including the attached two car garage. LPA observed sufficient emergency food and water. 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 in the kitchen and garage. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The exit gate was self-closing and self-latching. LPA observed sufficient seating and shading. The fire extinguisher was serviced on March 8, 2024, The auditory devices and smoke/carbon monoxide detectors were tested and operational. Emergency evacuation drills are conducted quarterly with last drills on March 28-29, 2025. The first aid kit contains all necessary elements. The Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the incorrect size. No discrepancies noted with resident/staff records. The following items were addressed during the exit interview: to enlarge the PUB475 to meet the required size of 20"x26," to assemble the emergency supplies and amend the Emergency Disaster Plan (LIC610D), to provide proof of last emergency drill, and expiration date of the administrator's certificate, and to maintain the hot water temperature in the resident bathrooms between 105-120 degrees Fahrenheit at all times. 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 Administrator Maryam Alamoutinia, and a copy of this report including the LIC809-D, LIC9102s, and the appeal rights were provided at the end of the visit.