Facility Evaluation Report

At 12:15 PM, Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection visit at the facility mentioned above. LPA met with the staff Jaizel Mabuti who granted access to the facility. The staff contacted the Licensee Starr Carver via telephone and LPA explained the purpose of the visit. The Licensee arrived shortly after.

LPA was informed that due to the heavy rain in March 2024, the office roof collapsed and the facility filed a claim with the insurance company to fix the roof. Due to the emergency situation the facility moved four (4) residents to Peaceful Kingdom Home Care I with License #197610244, located in 17740 Baltar Street Reseda, CA 91335 in April 2024. LPA was informed that the construction started on 05/10/2024. The anticipated date of the construction completion is unknown at this time. LPA was informed that no addition will be added to the facility to alter the original facility's map. During today's visit. LPA observed all rooms being vacant and did not observe any residents in care.

No deficiency issued during today's visit.

Exit interview conducted and copy of this report signed and delivered.