Post-licensing visit·March 12, 2026

On 3/12/2026, Licensing Program Analyst(LPA) Beena Singh conducted an unannounced post licensing visit. LPA was granted entrance by a Staff and Licensee Syed Iftikhar was contacted/informed and arrived during the visit. A tour of the facility was conducted inside and out of physical plant. Current census is two(2), one(1) resident present at the facility and one(1) is out in the community attending day program. There were two (2) staff present at the facility. The facility is approved for six (6) Non- Ambulatory Residents and Hospice Waiver for three (3). Dementia Plan is in place. An initial application to operate a Residential Facility for Elderly (RCFE)was submitted to the Central Applications Bureau (CAB) on 04/08/2025 for a total capacity of six (6) non-ambulatory. Fire clearance was granted on 08/05/25. LPA Singh observed the following: Facility is a one (1) story house with four (4) bedrooms, three (3) bathrooms, living room, dining area and kitchen. There was a two (2) car garage in the right side of the house. The inspection consisted of but was not limited to the following: Physical plant; bedrooms, bathrooms, living room, family room, kitchen, dining area, storage closets, laundry room, and outside premises. Each resident bedrooms accommodate any non-ambulatory resident. All resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, a lamp and an operable smoke/carbon monoxide alarm. There was a living/family room with adequate seating for all clients and a working TV.An adequate supply of linens was stored in a cabinet in the hallway of the residence . Patio furniture for outdoor seating observed. Self-latching handle gate on right side of the house leads into the backyard. All outdoor pathways were free of obstructions. Staff maintain resident medication records and medications are centrally stored in a locked cabinet. Two (2) resident files were reviewed for admission agreements, physician's reports, appraisals, needs and services plans. Two (2) staff files were reviewed First Aid/CPR certifications, criminal record clearances, personal record/history, training and health screenings. There is enough Emergency water supply and the required 72-hour emergency food supply for residents and staff available at the facility. Facility sketches were observed posted near the main entrance office. There was Let-Us-No poster, emergency disaster, personal rights, and Labor Laws observed. One (1) fire extinguisher was charged and located in the dining room/kitchen. Two (2) combined smoke detectors and carbon monoxide detectors were tested and were observed to be in working order. Residents records and staff records are stored in a locked cabinet in the hallway. First Aid kit with required components, and locked area for medication storage was observed. Liability Insurance effective date 3/9/2026-3/9/2027. The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of clients in care. Facility appears to be ready for license. An exit interview was conducted, and a copy of this report, LIC809 was discussed and provided to Facility Licensee Syed Iftikhar.