Facility Evaluation Report

Licensing Program Analysts (LPA) Vaid conducted an unannounced annual licensing inspection. LPA Vaid explained the purpose of the visit to Administrator Gladys Pervez, this facility is a Residential Care for Elderly (RCFE) to serve residents for age 60 and above. The capacity is six (6). Facility has a Dementia Care program for six (6) residents. Hospice waiver was approved for five (5). Administrator Gladys Pervez has an RCFE Certificate expiring on 02/08/2027.

During the visit, CARE tool was used, a tour of the facility was conducted, food supply was reviewed, staff were interviewed, files were reviewed, and medications were reviewed. The facility is a single-family house located in a residential neighborhood, consisting of a living room, laundry room, dining room, kitchen, five (5) resident rooms, two (3) bathrooms, front yard and backyard is furnished with shaded areas. Residents' rooms are furnished with appropriate furniture for residents’ comfort. The bathrooms are furnished with grab bars and nonskid surfaces. Adequate linen and personal hygiene supplies are observed. Common areas are observed for the ability to safely serve the needs of the residents. Smoke detectors and carbon monoxide detectors are hardwired and operational. Fire extinguishers are fully charged. Facility maintains a comfortable temperature for residents. Auditory alarm devices to monitor exits are operable. Sufficient supply of perishable and nonperishable foods is observed. Hot water temperature is measured at 109.8, 106.9 and 112.2 respectively, degrees Fahrenheit which is within Title 22 Regulation guidelines. Fire drill was conducted on 04/15/2026. Medication is centrally stored in a locked storage room and inaccessible to residents. Facility has first aid kit with manual. Resident records are stored in a locked storage room and inaccessible to residents. Liability insurance expires 12/16/2026.

No deficiencies were observed per California Code of Regulations, Title 22.

An exit interview was conducted. This report was discussed with Administrator, Gladys Pervez, whose signature on this LIC 809 form confirms receipt of these documents provided.