Routine inspection·May 19, 2025

On May 19, 2025, at 3:00 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 Administrator (ADMIN) Hany Fawaz The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, two (2) bathrooms, living area, dining area, kitchen, outdoor shed in the backyard, outdoor covered patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with ADMIN Fawaz. There were no bodies of water or obstructions in the facility. 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. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 105.6 degrees F to 110.8 degrees F. A comfortable temperature of 76 degrees F was maintained in the facility. LPA Kim observed the facility to be 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 both were available and maintained properly. Emergency food, emergency water, and emergency supplies are stored in garage. Evaluation Report Continues on LIC 809-C 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). All mandated inspection control posters were posted. A working telephone (714-602-7072) remains available. LPA Kim conducted an audit of resident files (R1-R4). Due to time constraints the following will be addressed on the subsequent inspection visit on a later date: staff files, medication and medication administration record, first aid kit, internet access device, staff interviews, resident interviews, and inspecting the smoke detectors and carbon monoxide detectors. No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report was provided to Administrator Hany Fawaz