Facility Evaluation Report

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced Plan of Correction (POC) visit regarding two deficiencies that were cited on 8/29/25. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Shahla Mirzaee. Staff Vinod Karpal arrived later in the visit on behalf of Administrator Sonya Karpal.

On 8/29/25 LPA cited two (2) deficiencies for unsecured laundry chemicals left out and for lack of an annually updated resident appraisal. The POC due date for both deficiencies was set for 9/12/25. LPA did not receive Plan of Correction items and Licensee did not communicate to LPA prior to the POC due date for additional time.

As the Licensee failed to correct the deficiencies and notify LPA by the due date, LPA conducted a POC visit to verify correction and to assess a Civil Penalty Violations for Failure to Correct. Two Civil Penalties (CPs) of $100.00 a day has been assessed from 9/13/25 to today's date (9/22/25) for a total of $2,000.00. The Civil Penalties will continue to be assessed at a daily rate until the deficiencies are cleared.

An exit interview was conducted with Staff Vinod Karpal to whom a copy of this report, the two (2) LIC 421FC forms, and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.