Routine inspection·July 23, 2024

Licensing Program Analysts (LPAs) Steve Chang and Marcela Yanez conducted an unannounced annual inspection visit, and met with Administrator (ADM) Mina Abbasvand . LPA observed 6 residents and 2 staff in the facility. LPA reviewed 3 residents files and 3 staff files. LPA observed one staff S1 on LIC500, but is not associated with the facility. ADM showed documents with S1's criminal clearance and he/she sent the criminal background clearance transfer request on 5/13/2022. LPA explained ADM should confirm that the employee is associated with the facility, then start to work for the facility. LPAs toured the facility inside and out and ADM. License, expired Administrator Certificate, and personal rights posters were observed in the facility. ADM showed the evidence that he/she renewed the Administrator certificate already. LPAs toured the facility inside out with ADM. Living room, kitchen, dinning room and three restrooms six single resident bedrooms, and laundry area were inspected at the first floor. 4 staff live-in rooms and one bathroom were observed at the second floor. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet and knives closet were observed locked. Cleaning product room was observed locked. Dish washing soap closet under the sink was observed unlocked. ADM locked the Dish washing soap closet under the sink before LPA finished the inspection. Room temperature was at 75 degree F, and hot water temperature was at 107 degree F in facility. The temperature of the refrigerator was at 40 degree F. ADM tested the call button system and call light system, and were working fine. First aid box and flash lights were observed at the facility. The last time the facility conducted the emergency drill is 6/8/2024. Continue on LIC9099-C. Page 1 of 2. Fire extinguisher was serviced on 4/19/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by staff, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. The detached garage was observed a storage room. Deficiency was noted today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. Page 2 of 2.