Faith Care Facility

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Sally Saif, Administrator. According to the facility’s license, the facility has a maximum capacity of four (4) residents, of all whom are ambulatory. Census is two (2). LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Residents bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water on the premises. Per Saif, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kits were complete and readily accessible. No deficiencies were cited on today's visit. An exit interview was conducted with Sally Saif, Administrator, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visitthe state’s words, verbatim · CDSS document, Jul 31, 2026

Type of visit: Prelicensing

Licensing Program Analysts (LPAs), Tiffany Holmes and Ramin Hashemi conducted an announced Pre-licensing inspection. An initial application to operate a Residential Care Facility for the Elderly was received on 05/28/2025. The facility was approved to care for four (4) Elderly Residents. LPAs were greeted and allowed entry into the facility by and met with Applicant, Sally Saif. Structure- The facility is a single story structure with 3 bedrooms and 2 bathrooms. There is an outdoor covered area for resident use. No bodies of water were observed. Bedrooms Residents- Rooms #1, #2, & #3, ambulatory use only. Bedrooms Staff- no staff room. Bathrooms- All bathrooms have a working toilet, sink, grab bars and tub/showers with non-skid mats. Linens & Hygiene Supplies- Adequate supply. Emergency Phone Numbers, Exit Plan and Required Postings- Posted. Smoke Detectors and Carbon Monoxide Detectors- connected. Appliances- Stove burners, oven, microwave, washer, and dryer working. Toxins- Stored in a locked cabinet. Water Temperature- Measured at 108 degrees F. Medications- Centrally stored and locked in a cabinet in the kitchen. First-Aid Kit- Stored in a locked cabinet. Resident & Staff Files- will be kept in locked cabinet. Activities- Adequate supplies to include magazines and puzzles for resident's use. Fire clearance- Approved on 03/20/2025. Component III- Conducted at the Pre-Licensing visit. Information provided about how to operate the facility within substantial compliance. All items reviewed during the visit are in compliance. Pre-licensing is complete and this facility has no deficiencies. Facility appears to be ready for licensure pending final review. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Applicant, Sally Saif signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: Initial Capacity: 4 Census (if any clients in care): 0 COMP II Participants: Sally Saif (CEO/Administrator) Interview Method: Virtual interview via Microsoft Teams On June 20, 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 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, Jun 20, 2025