Routine inspection·June 25, 2025

On June 25, 2025 at 1:15 PM 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 was greeted and granted entry by Caregiver (CG) Mavern Nichol. Administrator (ADMIN) Bahira Hanna was contacted over the phone and LPA explained the purpose of the visit. ADMIN Hanna stated to LPA Kim that they would not be able to attend today’s visit and CG Nichol could sign on the facility’s behalf. The facility is licensed to operate for six (6) non-ambulatory, of which 1 may be bedridden and have a hospice waiver for four (4) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: Six (6) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living area, dining area, attached 2 car garage, kitchen, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with CG Suzette Robinson. There are no bodies of water or obstructions on the premises. 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, Resident Room 5, Resident 6, and Staff Room 1. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 115.8 degrees F and 117.8 degrees F. A comfortable temperature of 78 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, and sharps objects were stored and not accessible to residents. . Evaluation Report Continues on LIC 809-C 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. LPA Kim observed emergency food and water are stored in the garage. The facility has smoke detectors and carbon monoxide detectors that were operable. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). Fire extinguisher is mounted in the kitchen. A working telephone (714-962-0250) remains available. First Aid Kit contained all the necessary elements. LPA conducted an audit of all resident files (R1-R3), and medication and medication administration record. Staff files for S1 and S2 were missing LIC501, LIC503, and training records. LPA Kim conducted three (3) resident interviews and one (1) staff interview. Deficiencies were cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). LPA observed S1's and S2's LIC501, LIC 503, and training records were missing. LPA observed front left oven burner was not lighting unassisted. A technical violation was issued for PUB475 measured at 8.5” by 11” instead of the regulated 20” x 26”. An exit interview was conducted and a copy of this report, LIC811, and appeal rights were provided to Caregiver Mavern Nichol.