Facility Evaluation Report

Licensing Program Analysts (LPAs) David Marrufo, Santino Fortes, and Kenneth Madrigal conducted a Pre-Licensing Visit and met with Faraviz Foshati, Licensee.

During visit, LPAs toured the facility inside and out. LPAs toured the kitchen area, hallways, bathroom, and three resident rooms. LPAs tested the smoke detectors in the hallway and three out of three resident bedrooms. All smoke detectors functioned properly when tested. LPAs tested two out of two carbon monoxide detectors and each carbon monoxide detector functioned properly when tested. The outdoor area was toured. LPAs toured the facility shed and found it to contain gardening items and other items. During tour of the external exit, LPAs observed that there were two locked gates preventing outdoor access out of the facility. LPAs observed that the water temperature in the facility sink was 119 F. LPAs observed that there were appropriate signs posted near the facility entrance.

During visit, LPAs reviewed the Component III presentation with Licensee Faraviz Foshati.

LPAs request that the following updates are made by 01/29/2025:

- Personal belongings of family members currently living in resident rooms are removed

- Personal belongings of the individual living in the garage/storage area are removed

- There are locked storage areas for cleaning supplies in both the kitchen and laundry rooms

- There are locked storage areas for resident and staff records

- The primary external gate remains unlocked

- The Facility Floor Plan is updated to reflect that the facility garage has been modified and converted into a storage area.

This report was reviewed with Licensee Faraviz Foshati and a copy of this report was provided.