Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced required annual visit. LPA met with Maria Campos, Caregiver and explained the reason for the visit. Administrator Hiransha Keerthisinghe and Assistant Administrator KM Dhammike Keerthisinghe arrived shortly after.

The facility is licensed to serve six (6) non-ambulatory of which two (2) may be bed-ridden. Waiver granted for Hospice Care for six (6). Currently there are three (3) residents on hospice care and one (1) bed-ridden resident in room number 3. The facility is operating within the scope of its license. Facility is in a residential area of Downey. A tour of the single-story facility included: 4 resident bedrooms, 1 staff bedroom, 2 resident bathrooms, living room, kitchen, dining area, office area, front yard, backyard, and de-attached garage.

LPA toured the facility and observed the following: Each resident bedroom has the required furniture and bedding. The Smoke detectors and carbon monoxide detectors were observed throughout the facility and are properly operating. The facility has one (1) fully charged fire extinguishers which is kept in living room. Cleaning supplies and toxic substances were observed to be inaccessible. LPA observed two knives and a pair of scissors in kitchen drying rack accessible to residents in care. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Facility had a sufficient supply of 2 days perishable & 7 days non-perishable foods. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The resident bathrooms have the required grabs bars and non-skid mats. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents in backyard. LPA observed a large hole on ramp leading to backyard. LPA reviewed Infection Control Plan and Emergency Disaster Plan. Last emergency drill was conducted on 02/02/2026.

***Due to time constraints, LPA was not able to complete the annual inspection for this facility. LPA will do a continuation of this inspection. ***Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided to Hiransha Keerthisinghe.