Routine inspection·May 20, 2025

On May 20, 2025, at 10:15 AM, 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) Anna Stelle. Administrator (AD) Ameer Attrah arrived at the facility around 11:02 AM and LPA Kim explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents, of which one (1) may be bedridden in bedroom #3, 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) staff rooms, three (3) bathrooms, living area, dining area, kitchen, outdoor covered patio, and a detached two car garage. LPA Kim toured inside and outside of the physical plant with Licensee Ahmed Attrah. There were no obstructions in the facility. The garage was inspected and the LPA observed the garage has a constructed room and area that has a closet, sink, and a shower that does not reflect in the sketch. The sink and shower are non-operational but have pipes connected through different walls. 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 113.0 degrees F. A comfortable temperature of 75 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C 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 and emergency supplies are stored in the office next to the kitchen. Emergency water is stored to the wall next to the caregiver room. The facility has one (1) fire extinguisher that is charged and mounted on the wall in the kitchen and was inspected on July 18, 2024. 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. The smoke detectors and carbon monoxide detectors were operable. A working telephone (657-221-3232) and video teleconferencing computer is dedicated to the residents both remain available. Emergency drill was conducted on March 21, 2025, and is conducted quarterly. First aid kit is maintained and contains all the necessary elements. Evidence of Liability Insurance is effective September 14, 2024, and expires September 14, 2025. LPA Kim conducted an audit of resident files (R1-R5), staff files (S1-S4), and medication and medication administration record were all in order and complete. LPA Kim conducted two (2) resident interviews and one (1) staff interviews. A deficiency was cited during this visit per Title 22 Division 6 Chapter 8. LPA observed the garage has a three constructed walls that has room and an area that has a closet, non-operational sink, and non-operational shower that is not reflected in the facility sketch. An exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator Ameer Attrah