Routine inspection·December 17, 2024

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Ashkan Bastani and explained the reason for the visit. The Administrator's certificate expires on October 22, 2025. Facility is licensed for a capacity of 6 non-ambulatory residents of which one can be bedridden and hospice waiver for 4. Facility is a singe story home with 5 bedrooms (1 is for staff), 2 bathrooms, kitchen, living room, dining room and a two car garage. The garage is kept locked and used for storage. Facility is operating within it's license. LPA observed the fireplace in the living room is screened. LPA observed the See Something Say Something Poster posted in the hallway next to the front door. LPA observed the kitchen is clean and organized. The 5 burner gas stove lights unassisted. LPA observed the cleaning supplies are kept locked under the kitchen sink and knives are kept locked in a kitchen drawer. The fire extinguisher in the kitchen is fully charged. Medication is kept locked in a cabinet in the hallway. LPA observed a clean linen supply in the hall closet. LPA observed all resident rooms had the required furnishings. LPA observed both bathrooms are clean and operational. Hot water measured 120.0 degrees Fahrenheit in both bathrooms. LPA observed Resident 1 (R1) had a bed rail on their bed but did not have a doctor's order for a bed rail. LPA observed the backyard had a table with chairs and an umbrella to sit outside. No bodies of water observed in the backyard. Both exit gates are operational. No obstacles or hazards observed in the backyard. LPA reviewed resident files and medications. LPA observed 5 out of the 6 resident files had no discrepancies. Resident 1 had a bed rail but no doctor's order for a bed rail. Smoke detectors/carbon monoxide detectors were tested. There is a smoke detector in each hallway on both sides of the house, both smoke detectors (2) in the hallways were not operational. All smoke detectors in the living room and in each bedroom are operational. During the visit the batteries were changed in the 2 smoke detectors in the hallways and both hallway smoke detectors are now operational. LPA reviewed 2 staff files, there was no documentation for any current training for both staff members. LPA observed Staff 1 had current CPR/First aid training. The last fire drill was conducted on November 10, 2024. The first aid kit has ll the required elements. Facility has a dedicated internet device for resident use. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. A civil penalty was issued on this date. An exit interview was conducted with the Administrator and a copy of the report along with appeal rights and LIC 421IM (civil penalty) was provided.