Facility Evaluation Report

On 5/12/25 at approximately 12:00pm an unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena Khurshudyan. Upon arrival, LPA met with the Caregiver Rina Bayani, who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. Shortly after the Administrator, Wood Cherie arrived and helped with staff/residents’ files and medications.

During today's visit, LPA conducted a physical plant walk through, at approximately 12:55pm, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22.The following was observed: The facility is a single-story home and is licensed for capacity of six (6) residents, of which four (4) may be non-ambulatory and of which fire clearance for one (1) Bedridden. Facility also has a hospice waiver for four (4) residents. There are five (5) bedrooms of which four (4) are designated for residents’ use. All bedrooms observed to be appropriately furnished and have appropriate lighting. There are two (2) bathrooms in the facility designated for residents’ and staff use. LPA observed bathrooms have soap, paper towels and hand washing signs. The hot water temperature measured at 1:13pm to be 136°F. Extra towels and linens were readily available in the linen closet located in the hallway. There are grab bars for each toilet and shower, bathrooms have non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination.

LPA observed facility alarms were present on all exit doors, however, the signals were off / Non-operational.

SMOKE DETECTORS/CARBON MONOXIDE. The smoke detectors and carbon monoxide are hard wired, inter-connected and were located throughout the facility. At 3:30pm they were tested and observed to be operational. The facility has one (1) fire extinguisher that was last purchased on 5/12/2025.