Facility Evaluation Report, 11/04/2021 — Prime Care Manor, Garden Grove CA

Licensing Program Analyst (LPA) Albert Marin made an unannounced case management visit. LPA met with Administrator (AD) Abdul Arastoo; and stated the purpose of this visit. The purpose of this visit is to continue the case management conducted last November 2, 2021.

On the initial visit, LPA Albert Marin and LPA Jerome Haley conducted a physical tour of the facility that included but not limited to Building A (structure close to the street / main entrance), Building B, and facility grounds. Building A have the common dining area, office and medication room, kitchen, clients rooms and common bathrooms. Building B have common bathrooms, laundry area, patio and client's rooms.

The following were the initial observations: LPAs Marin and Haley that there was only one staff on the floor. Lunch service was completed, and staff was in the kitchen doing dinner meal preparation. LPAs observed that the kitchen was in order; facility met the minimum two day perishable and seven day nonperishable food stock requirements; and menu plan posted. At 11:32 AM, LPAs observed about 14 pieces of persimmon in a bowl and did not observe any other fruits available. When AD Arastoo arrived in the facility about 15-20 minutes after receiving the call, LPAs started the tour with AD Arastoo. In Room A2, LPAs observed a broken light switch cover. About 11:45 AM LPAs and verified with AD, Building A did not have a Carbon monoxide (CO) detector in place; one of two common bathrooms had a broken shower wall and with black discoloration towards its lowest portion. LPAs did not observed any soap or paper towel. The facility had a centralized fire alarm system. The central panel is located in Building A. LPAs randomly observed that the ceiling sensors were lit green. LPA Marin requested a copy of the latest fire inspection on the system from AD Arastoo. AD agreed to provided Community Care Licensing Division with a copy on or before 5:00 PM of November 18, 2021.

The tour continued to Building B. At 11:53 AM, LPAs Marin and Haley observed and verified with AD, there were two CO detectors place on the wall but were not in working conditions. All three common bathrooms did not have soap and paper towels; and one was observed to be stained. (Page 1)