Facility Evaluation Report

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Fahimeh Rassouli and explained the reason for the visit. The Administrator's certificate expires on November 2, 2027. The facility is licensed for 6 non-ambulatory residents of which 1 may be bedridden and a hospice waiver for 4. The facility is a single story home with a living room, dining room, kitchen, laundry room, 7 bedrooms, 1 is for staff, 2 bathrooms and a 2 car garage. The garage is kept locked and used for storage. LPA and the Administrator toured the facility. LPA observed the See Something, Say Something poster (PUB 475) posted next to the front door of the facility. LPA observed all 6 resident rooms have the required furnishings. The smoke detectors/carbon monoxide detectors tested operational. The Fire extinguisher in the kitchen is fully charged (purchased 12/31/25). LPA observed a 2 day supply of perishable food and a 7 day non-perishable food supply on hand in the kitchen. LPA observed a 3 day emergency food and water supply stored in the kitchen. LPA observed knives are kept locked in a kitchen drawer. LPA observed the medication and cleaning supplies are kept locked in the laundry room. LPA observed both bathrooms are clean and operational. Hot water measured 118.0 degrees Fahrenheit in both bathrooms. LPA and the Administrator toured the backyard and the garage. LPA observed the garage is used to store extra supplies and food and old furniture. The garage is kept locked and cannot be accessed from inside the facility. The backyard has a table with an umbrella and chairs to sit outside. The backyard exit gate is operational. There is a fenced pool at the front of the house. The fence is 5 feet tall. The gate for the pool fence is secured. The pool is inaccessible to residents. LPA reviewed facility files. The last fire drill was conducted on January 10, 2026. LPA observed the first aid kit has all the required elements. LPA reviewed 2 staff files, both staff members have the required training and CPR training. Both staff members are background cleared and associated to the facility.