Aday

Type of visit: Required - 1 Year

On 1/21/2026, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Abera Kassa /Licensee. LPA explained the purpose of today’s visit. The facility is licensed to serve (6) elderly adults ages 60 and above, of which (6) can be non-ambulatory. Currently the facility has (0) residents. The facility is a single-story building located in a residential neighborhood. It consists of (5) bedrooms, (3) full bathrooms, a living room, dining room, kitchen, shaded back yard, front yard, laundry room, and attached two-car garage. LPA Iniguez and the Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of (5) bedrooms and (3) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were operational. Smoke and carbon monoxide detectors were in operable condition. The water temperature ranged from 113.5°F to 115.2°. The evaluation Report continues on the next page, LIC 809-C, providing further details of the inspection findings. During the visit, LPA Iniguez observed that the facility was clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there were sufficient perishable and non-perishable food available, which was adequately maintained. All fire extinguishers were charged and operable. LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. A copy of liability insurance was emailed to LPA. Facility Annual Fess current. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies during this visit; therefore, no citations were issued. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Abera Kassa / Licensee.the state’s words, verbatim · CDSS document, Jan 21, 2026

Type of visit: Prelicensing

On 01/06/2025, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an announced pre-licensing visit to this home. LPA was greeted by applicant Abera Kassa and explained the purpose of today’s visit. LPA was given access to the facility. An application was submitted to CCLD on 06/03/2024 for an initial license application for a Residential Facility for the Elderly, ages 60 years and above. The applicant requested a capacity of six (6) non-ambulatory residents. Structure: The home is a seven (7) bedroom, three (5) bathroom, one story home with detached garage situated in a residential neighborhood. The home includes a living/dining room, kitchen, and laundry area. The living area included sectional seating. The kitchen has a refrigerator and stove. Passageways, walkways, and steps inside and out are free from obstructions. Bedrooms Residents: The facility has six (6) bedrooms for residents. All resident bedrooms include a bed, chair, and a nightstand. All bedrooms are equipped with ceiling lights and dressers, which comply with the requirement of 8 cubic feet of space. All rooms had closets for ample storage. Bedrooms Staff: One bedroom is designated for Administrator. Bathrooms: The home has five (5) bathrooms, one of which is in the Administrator bedroom. All bathrooms have a working toilet, washbasin, and shower with grab bars and non-skid mats. Linens & Hygiene Supplies: Beds have the required linen supplies which include, pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. An adequate supply of linen is stored in the garage. Emergency Phone Numbers, Exit Plan & Menu: Emergency phone numbers. The exit plan and menu are posted and readily available for review throughout the home. There is one (1) fire extinguisher located in the kitchen mounted on the wall. Facility has a working telephone which was called by LPA and found to be operational. Emergency supplies and Personal Protective Equipment supplies are stored in the garage. The applicant has an approved Infection Control Plan on file. Food Service: Dishes, cups, and flatware are stored in the kitchen cabinets, inspected, and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a locked kitchen drawer. Food supply is adequately stored and consist of (2) day supply of perishables and a (7) day supply of non-perishables. The kitchen counters also had small appliances. Smoke Detectors: Smoke and carbon monoxide detectors throughout the interior space. Hardwired smoke detectors/carbon monoxide in all bedrooms and hallways. Toxins: All toxins are locked and stored in a locked space under kitchen sink. Appliances: Kitchen appliances found to be within title 22 requirements. Home is equipped with central heaters and air conditioning systems. Water Temperature: The water temperature was found to be withing title 22 regulations throughout the kitchen and bathrooms. Medications, First-Aid Kit & Book: A first aid kit is stored in a cabinet in the kitchen, and contained thermometer, tweezers, scissors, antiseptic, bandages, gauze, and a current first aid manual locked and inaccessible to residents. The resident's medications will be stored in a cabinet locked in the kitchen area and inaccessible to residents. Resident & Staff Files: Records of staff and residents will be stored in the office area located in the Administrator bedroom. Reading Material, Games, Equipment & Materials: The facility has board games, books, magazines, and other recreational materials for the resident's use all stored in the living room. Pool/Jacuzzi & Pets: There are no pets, jacuzzi, or pool on premises. A Fire Clearance inspection was conducted on 09/17/2024 and approved for a capacity for six (6) non-ambulatory and zero (0) bedridden residents ages 60 and over. LPA Gonzalez noted the following correction needs to be made: · Resident bedrooms shall be provided with a minimum of eight (8) cubic feet (.743 cubic meters) of drawer space per resident. An exit interview was conducted, and a copy of this report was provided to Abera Kassa, facility Administrator.the state’s words, verbatim · CDSS document, Jan 6, 2025

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Initial Capacity: 6 Census (if any clients in care): none COMP II Participants: Abera Kassa, Applicant/Administrator Interview Method: Virtual interview (Microsoft Teams) On December 6, 2024 at 9:20 AM, Applicant/Administrator participated in COMP II. Identification of the Applicant/Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant/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. 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 Readiness Exit interview conducted with Applicant/Administrator. Report sent via email and request to return sign copy to CAB by end of business day today.the state’s words, verbatim · CDSS document, Dec 6, 2024