Routine inspection·August 4, 2025

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Shujen Collado. During the visit, LPA observed 6 residents and 3 staff. LPA explained the purpose of the visit. Ebadat Residential Care Home #6 is a level 4i home. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 3 restrooms and 4 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 73 degrees F, and hot water temperature was measured at 109 degrees F in resident bathrooms. Fire extinguisher was serviced in August 2025. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on August 20, 2024. LPA reviewed facility records for 3 staff and 3 residents. LPA asked for Staff S1's completed health screening form was. LPA pointed out S1's health screening did not have the evaluation of general health/ evaluation of ability to preform work / note any health condition/ the physician's stamp/signature. ADM stated S1 would get a new updated health screening in 1 week. Page 1 Out of 3. LPA reviewed 3 resident medications and centrally stored medication records. LPA reviewed 3 resident P&I records. While touring the facility office, LPA observed two partition walls and an additional door. These two walls and door way isn't reflected on the facility sketch. LPA observed in inside the partitioned bedroom a staff member. ADM stated two staff members use the office as a sleeping area. LPA also noted that a staff member was sleeping in the office area. LPA spoke to Licensee (LN) Kourosh Ebadat. LN stated he just got a permit approval in May 2025, to convert it to a two bedroom, 1 bath ADU. LN confirmed that there are two staff sleeping in the office. LN confirmed the additional bedroom in the office area, at its current state does not have a permit. While touring the sitting room, LPA observed, a partition wall. Note, this partition is not noted on the facility fire clearance. Furthermore, the fire clearance notes an opening between the sitting room and the living room. Based on empirical observation, there is a wall between both rooms. LN stated the sitting room-living room did not have an opening for crossing. LN stated there was a slight opening approximately 3 feet tall, and 8 foot wide. LN stated he did block that opening. LN also confirmed he did put a partition - half wall in the sitting room. LPA toured the facility shed in the backyard. LPA noted there was a mattress, cloths, medications. LPA also observed a power cord from the facility, heading inside the shed. LPA also noted there was a fan, a heater pointed towards the bed inside the storage shed. ADM confirmed there is a staff who sleeps in the shed. LPA provided ADM with copy of PIN 25-08-ASC. Page 2 Out of 3. LPA requested copies of the following forms: 1. LIC500, Personnel Summary 2. LIC308, Designation of Administrative Responsibility 3. LIC400, Affidavit Regarding Client/Resident Cash Resources 4. Liability Insurance 5. LIC200, please update (i.e., new phone numbers etc), if necessary. 6. Qualifications of Administrator (Certificate) 7. Please review your facility program for updates (incorporating new laws and/or regulations) 8. LIC309, Administrative Organization Deficiencies cited during today's visit, see LIC809-D. This report was reviewed with Licensee (LN) Kourosh Ebadat. and a copy of the signed report was provided. Appeal rights were provided. Page 3 Out of 3. END OF REPORT.