Pre-licensing visit·December 2, 2025

Licensing Program Analyst (LPA) Andrea Mendivil made an announced visit to conduct a pre-licensing inspection. LPA identified themselves and discussed the purpose of the visit with Licensee Ali Naghibi an initial application to operate a Residential Care Facility for the Elderly application was received by CCL on 03/01/2025, for a capacity of six residents 5 non-ambulatory and 1 bedridden resident. LPA Mendivil along with Licensee toured the facility at 01:05PM and observed the following: Structure: Facility is a single story, 7 bedroom, 7 bathroom house with an attached garage and beige exterior. The exit gates are unlocked and self latching. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: 7 bedrooms are single occupancy. All of the rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Bathrooms: Resident bathrooms have a working toilet/ wash basin . Linens & Hygiene Supplies: Facility has bedding and towels for residents in care. Emergency Phone Numbers and Exit Plan: Posted in dining room. Food Service: Licensee has 2 day perishable and 7-day nonperishable foods. Smoke Detectors: Smoke detectors/ carbon monoxide detectors were tested and operational. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins / Sharps : LPA observed a secure area for sharps and toxins. Water Temperature: LPA tested hot water and it read as following: residents bathroom tested between 109 to 113 degrees Fahrenheit . Emergency Supplies: LPA observed supply of emergency water and food. Medications, First-Aid Kit & Book: First aid kit observed contained all required items. CONTINUED ON LIC 809C DATED 12/02/2025. Medication is stored in secured laundry room. Resident & Staff File: Records are stored in a locked cabinet Reading Material, Games, and Equipment: . LPA observed games and coloring books in facility. Backyard : LPA observed a shaded area for residents. Fire Clearance: Approved for 5 non-ambulatory and 1 bedridden residents on August 26th, 2025. Facility is ready to be licensed. Component III completed. Exit interview conducted and a copy of this report was left at the facility.