Facility Evaluation Report

On 4/7/2026 at 9:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Administrator, Fathma Ansari and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory.

LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 8 total bedrooms which 6 bedrooms are occupied by the residents and 2 bedroom are occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathrooms was measured at 116.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents.

Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 02/24/2026. First aid kit was observed to be complete. Emergency Disaster plan last reviewed on 2/1/2026. Emergency disaster drill was last conducted on 3/1/2025.

At 10:00 AM, LPA reviewed 4 of 4 residents records. At 10:30 AM, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility.

Updated copies of the following documents were requested for facility file and are to be mailed to CCL by 4/20/2026:

LIC 308 Designation of Administrative Responsibility

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.