Routine inspection·February 20, 2025

Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced visit for a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Licensee Miriam Mehzun Hadgu. According to the facility’s license, the facility has a maximum capacity of six (6) elderly residents age 60 and above, one (1) of whom may be non-ambulatory in bedroom #1. The facility has a hospice waiver for 2 residents. During today’s inspection, there were a total of two (2) residents in care. This facility does not feature a secured perimeter or delayed egress doors. During today’s visit, LPA observed two residents in care both of who were non-ambulatory. A review of the Physician Report indicated that R1 was non-ambulatory and R2 was also non-ambulatory due to using a walker and the facility only has clearance for one non-ambulatory resident. Due to time constraints, a return visit on a subsequent day is needed to complete the annual inspection. One deficiency was cited per California Code of Regulations, Title 22 for violation of facility's fire clearance.(refer to the attached LIC 809-D). A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with Miriam Mehzun Hadgu, to whom a copy of this report, the LIC809-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.