Pre-licensing visit·August 5, 2025

Licensing Program Analysts (LPAs) Celine Rodriguez and Garlli Tat conducted an announced visit for the purpose of conducting the Pre-Licensing visit for a Change of Ownership (CHOW). LPAs conducted the visit with Applicant/Administrator (AD) Khojesta Azizi. The initial application to operate a Residential Care Facility for the Elderly (RCFE) was received by the Department of Social Services on July 29, 2025 for age range 60 and over, of which 6 may be on hospice, 5 may be non-ambulatory, and 1 bedridden. For this visit, there are a total of 6 residents in care. Structure: Facility is a single level structure. On 3/18/2025, The Orange County Fire Authority granted a fire clearance for a capacity of 6 residents (which 5 may be non-ambulatory, and 1 may be bedridden). There are a total of 7 bedrooms, which 6 are private resident rooms and 1 room designated for staff. Bedrooms: All bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept hazard free. Bathrooms: There are a total of 3 restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature was measured to be at 118.4 degrees Fahrenheit. Linens and Hygiene Supplies: Adequate supply of linens is stored in the hallway cabinet. Posters, Emergency Phone Numbers, Exit Plan: LPAs observed the PUB475 "See Something, Say Something" poster, emergency disaster plan, and administrator certificate for Khojesta Azizi which expires on July 17, 2026. These were posted at the main entrance. Continued on LIC809-C... Food Service and Menu: Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to the residents in care. Facility had back-up emergency food and water supply located in the pantry. Smoke and Carbon Monoxide Detectors: Smoke and carbon monoxide detectors were tested and operational. Alarms: There are auditory alarms located on all exit doors of which all were tested and operational. Fire Extinguisher: Fully charged, mounted, and located in the kitchen and tagged for 2025. Appliances: Stove is a four-burner induction stove, and there is single oven, dishwasher, refrigerator and freezer. Washer and dryer are located inside the garage. Toxins: Locked and inaccessible to residents. Medications, PPE First-Aid Kit and Manual: LPAs observed that First Aid Kit had all the required components. Medications were locked in a cabinet located in the kitchen. Backyard: No bodies of water were observed. There are 2 exit gates in the backyard, of which both are self-closing and self-latching. Resident and Staff Files: Records were kept in a locked cabinet located in the kitchen. Recreational Activities: The facility has activities that commensurate with plan of operation. LPA Rodriguez reviewed the Component III with AD Azizi. Per interviews, Licensee/Administrator stated that they are not planning to advertise for special dementia program for this facility as of this time. Pre-licensing visit and Component III are now complete. LPAs will provide copy of this report to Centralized Applications Bureau for review and final determination of the application. LPAs advised AD Azizi to utilize the main office email: CCLASCPOrangeCountyRO@dss.ca.gov for additional inquiries. LPAs conducted an exit interview with AD Azizi, and a copy of this report was provided to the facility.