Elderhart

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA was met by Jay Catacutan and Daniela Cortez, Caregivers and explained the purpose of the visit. The administrator, Hanna Seidfathi was called on the phone and arrived shortly thereafter to assist LPA. The facility is licensed to serve adults ages 60 and over. Approved for six (6) non-ambulatory residents of which one (1) may be bedridden in bedroom #1. Waiver/granted for hospice care for six (6). There are (4) residents residing in the home, but (1) resident is currently hospitalized. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: The facility is a single-story home located in a residential area consisted of four (4) bedrooms, three (3) bathrooms, kitchen, dining room, living room with covered fireplace, laundry area, attached garage, and a backyard with seating and shade. Front entry and all exits have a wheelchair ramp. The facility has an updated Infection Control Plan in place. Staff are adhering to infection control requirements. The facility has a valid Liability Insurance policy, expires on 11/10/2026. The facility does not handle residents' cash resources. Fire Drill is conducted on a quarterly basis, last drill was conducted on 09/05/2026. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, night stand, overhead lighting, chair and sufficient closet space. Beds and furnishings are in good working condition. Bathrooms were clean and contained a working toilet, basin, and water faucet, shower with non-skid mats. One (1) fully charged fire extinguisher was observed, purchased on 07/17/2026. Attached garage was inspected and there are extra refrigerator and freezer stocked with additional food items. Cleaning supplies are stored in the cabinet at the garage and inaccessible to residents. Kitchen knives, sharps objects, are kept locked in a kitchen cabinet. Smoke alarm/carbon monoxide combo was tested and operable. There are cameras without audio inside (common areas only) and outside of the facility. Backyard was inspected and has a shaded area and sitting area. No bodies of water were observed. LPA observed (2) buckets of left over paint and a wood pile in the side yard that need to be cleared out. Hot water was tested in bathroom #1 and measured at 112.6 deg F which was within normal limits 105 degrees Fahrenheit and not more than 120 degrees Fahrenheit. ***CONTINUED ON LIC809-C*** There are (7) staff including the night shift and administrator providing care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and are associated to the facility. LPA reviewed (4) staff files that include: personnel record, staff training, health clearance, employee rights, and 1st Aid/CPR/AED training. Administrator certificate is valid and expires on 06/11/2027. Resident personal rights are posted. Facility provides internet service to all residents and have access to the facility phone. The indoor activity area is appropriately furnished and comfortable for residents' relaxation. Outdoor activity areas have adequate shady areas. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. There are sufficient food supplies of 2-day perishable and 7-day non-perishable items. There are (0) residents with modified or restricted diets. Emergency water supply was observed. All the appliances are working and in good condition. Cleaning supplies and toxins are locked only accessible to staff. LPA reviewed (4) resident files which include Face Sheet, Physician's Report (including TB and Ambulatory Status), Admission Agreement, Appraisal Needs Services plan and Residents Rights observed. LPA observed that (1) of (4) residents did not have a physician's order for half bed rail on file. The medications are centrally stored and in their original containers. All (4) residents' medications were reviewed to confirm medication is given as prescribed and is documented properly. The facility uses the Medication Administration Record (MAR) log to document that medications are given according to Physician directions. There are no residents with restricted health conditions. The facility has an Emergency Disaster Plan posted with contact numbers and at least two (2) relocation sites. No deficiencies cited. Technical advisories issued. Exit interview was conducted and a copy of this report was provided to Hanna Seidfathi.the state’s words, verbatim · CDSS document, Sep 17, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Daniel Konishi made an announced visit and met with the Applicant, Hanna Seidfathi to conduct an announced Pre-Licensing evaluation. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: An application was submitted to Community Care Licensing Department (CCLD) for an initial application of a Residential Care Facilities for the Elderly (RCFE) to serve adults ages 60 and over. Approved for six (6) non-ambulatory residents of which one (1) may be bedridden in bedroom #1. Waiver/granted for hospice care for six (6). Structure: Facility is a single-story home located in a residential area consisting of four (4) bedrooms, two (2) bathrooms, kitchen, dining room, living room, garage, and a backyard with seating and shade. Front entry and all exits have a wheelchair ramp. Operational Requirements: The facility did not have proof of liability insurance during today's visit and that they were instructed to obtain the liability insurance prior to accepting the first resident and will submit proof of that insurance to the department once it is obtained. Bedroom Clients: Bedrooms are equipped with a bed, nightstand, chair, lamp, dresser, trash bins, and overhead lighting. Bathrooms: two (2) full bath equipped with working toilet, wash basins, shower. Linens & Hygiene Supplies: All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linens is stored in linen closets. Emergency Phone Numbers, Exit Plan: Emergency numbers and Exit plans are posted and readily available for review. One (1) fully charged fire extinguishers was observed. Facility has a land line telephone. [Continue in LIC809-C] Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils were observed locked and inaccessible. Adequate food supply is stored in the kitchen and consists of the following: 2-day perishables, and 7-day non-perishables. Emergency water supply was observed. Carbon Monoxide/Smoke Detectors: Carbon Monoxide and Smoke Detectors were observed, tested, and working properly. Appliances: Refrigerator, oven, microwave, dishwasher and washer/dryer are in good condition. The residence is equipped with central heating and air conditioning. Toxins: Cleaning supplies, and toxins are locked only accessible to staff. Water Temperature: Hot water was tested in all bathrooms, and kitchen sink. Water temperature was within normal limits 105 degrees Fahrenheit and not more than 120 degrees Fahrenheit. Medication, First-Aid Kit & Book: Designated centrally stored medications cabinet, and the first-aid kit has been inspected which has at least the following: tweezers, scissors, antiseptic, bandages, gauze, thermometer; including a current First Aid manual. Resident & Staff Files: Designated area for files will be in a locked closet. Pools/Jacuzzi/Body of Water: No bodies of water were observed. Fire Clearance: Fire clearance was approved on 06/11/2025 for six (6) non-ambulatory residents of which one (1) may be bedridden in bedroom #1. Waiver/granted for hospice care for six (6). Component III: Component III was reviewed during inspection. Pre-Licensing is complete, and this facility has no deficiencies. Exit interview was conducted with the Applicant, Hanna Seidfathi and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 20, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Hanna Seidfathi CEO/Administrator Interview Method: Telephone interview On September 30, 2025, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-Licensing Readinessthe state’s words, verbatim · CDSS document, Sep 30, 2025