Amari House

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced Case Management visit. Upon arrival, LPA was granted entry and met with Licensee Mushaira Mosharraf. LPA explained the purpose of the visit. The purpose of the visit was to follow up on nine Unusual Incident Reports (UIRs) submitted by the facility on April 30, 2026, and to determine whether any of the reported incidents resulted in a violation of Title 22 regulations. During the visit, LPA reviewed all nine incident reports with the Licensee. Based on the information reviewed and discussed during the visit, LPA confirmed that the reported incidents did not result in any Title 22 violations. No deficiencies were observed during today’s visit. An exit interview was conducted, and a copy of this report was provided to the Licensee at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 7, 2026

Allegation investigated: Staff did not change resident for an extended period of time Staff does not provide meals to resident Staff does not ensure resident is hydrated

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to investigate a complaint received in the Regional Office. LPA was greeted and granted entry by Staff #1 at 1pm. LPA met with Administrator Mushaira Mosharraf and Administrative Designee Shaira Mosharraf and explained the purpose of the visit. The facility recently opened on March 25, 2026 and has two residents and two staff members. On April 11, 2026 the Power of Attorney (POA) for Resident #1 (R1) requested R1 be sent out to the Emergency Room. At time of incident, Occupational Therapist (OT) had been with R1 when POA made the request. Paramedics assessed and asked staff why they were called. Administrator stated POA called and wanted R1 transported to Anaheim Regional Center. R1 returned to facility on April 13, 2026 and POA contacted . Anaheim Police Department to conduct a welfare check on April 13, 2026 at 11:29pm. AD spoke with PD during the welfare check and resident was not in distress and was fast asleep. No problems were noted. (Continued on LIC 9099-C) Unfounded (Continued from LIC 9099) LPA reviewed two of two resident files and obtained copies of the following: Resident Admissions Agreements, Medical Assessments, Appraisal Needs and Services Plans, and Durable Power of Attorney Paperwork. LPA also reviewed Unusual Incident Reports filed with the Department on March 11th and March 13th regarding Resident #1 (R1) and a SOC 341 Report of Suspected Elder Abuse received by the Department on April 13, 2026. Facility cross reported to Adult Protective Services (APS), Long Term Care Ombudsman (LTCO) and Anaheim PD LPA also reviewed discharge instructions from Anaheim Regional Center. It was alleged that Staff did not change resident for an extended period of time. LPA interviewed two of two residents to inquire if they are not being changed in a timely manner. Two of two residents denied the allegation. One resident verbalized they were changed often by staff. Staff stated Resident #1 (R1) received showers by a bath aide one a week but is sponge bathed every day. Staff also stated residents are changed three to four times per day. Resident #1 (R1) is non-ambulatory and requires assistance with Activities Daily Living (ADL) per Medical Assessment dated March 26, 2026 with a diagnosis of dysphagia and mild cognitive impairment.. Staff stated residents are checked prior to breakfast, after lunch, after dinner and prior to going to bed with additional checks, as needed. Three of three staff denied this allegation. The allegation that staff was not changed for two weeks was Unfounded. LPA investigated the allegation that Staff does not provide meals to resident. LPA interviewed two of two residents. When asked if they were fed, two of two residents stated they were being fed meals. Resident #1 (R1) stated to LPA that, Yes, they were being fed meals and that they were nothing fancy but keeps R1 alive. LPA asked if R1 would like more food to which R1 stated they were fed enough food. LPA observed in the medical assessment that R1 is to be fed a pureed diet and staff confirmed R1 must be fed by the staff. Upon interview with staff, three of three staff denied the allegation that staff does not provide meals to the resident. The primary staff member who is with the resident stated they prepare the meals for both residents and hand feeds each resident. Staff prepares meals for breakfast, lunch, dinner and snacks. The allegation that staff does not provide meals to residents is Unfounded. It was also alleged that Staff does not ensure resident is hydrated. LPA observed two of two residents with clear water bottles with straws. Staff constantly remind residents to drink water and monitor the clear water (Continued on LIC 9099-C1) (Continued from LIC 9099-C) bottles One resident has a pink rimmed bottle, the other has a blue rimmed bottle. Water is readily available to residents at their bedside and on their person if they are moving about the facility. Interview of three of three staff stated both residents drink approximately two and a half water bottles. Each water container is approximately 16 ounces so residents receive approximately 32-40 ounces of water daily. Per interviews with residents, two of two residents confirmed they have access to water. The allegation that staff does not ensure resident is hydrated is Unfounded. Based on LPA observations, record review and interviews, the allegations that Staff did not change resident for an extended period of time, Staff does not provide meals to resident and Staff does not ensure resident is hydrated are Unfounded. The allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted with Administrator Mushaira Mosharraf and Administrative Designee Shaira Mosharraf and copy of this report, and LIC 811 were provided to the facility.the state’s words, verbatim · CDSS document, Apr 21, 2026 · control 22-AS-20260414100151

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced annual visit. LPA was granted entry and met with Licensee Mushaira Mosharraf. The purpose of the visit was explained.The facility is a one-story home with an attached two-car garage. It consists of four bedrooms, one designated for staff, two bathrooms, a dining room, kitchen, and living room. At the time of the inspection, the facility did not have any residents in care and has not admitted residents since licensure. LPA toured the facility and inspected all prospective resident bedrooms. Each contained the required furnishings and elements. Both restrooms were inspected and found to be clean, functional, and equipped with all required supplies. No mold or mildew was observed. Hot water was tested and measured at 120 degrees Fahrenheit.As the facility has not been active, there were no resident or staff records available for review, and no medications to inspect. Knives, sharps, and cleaning chemicals were stored securely and were inaccessible to future residents. Fire extinguishers were observed on site, purchased on July 16, 2025.The outdoor area included shaded seating with tables and chairs available for future resident use. Emergency exits were observed to be clear and free from obstruction.No deficiencies were observed during the inspection. An exit interview was conducted, and a copy of this report was provided to the Licensee at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 2, 2025

Type of visit: Prelicensing

On August 23, 2024, 9:00am Licensing Program Analyst (LPA) Edward Kim conducted an announced Pre-Licensing continuation visit. LPA Kim was allowed entry and met with Applicant Mushaira Mosharraf. The purpose of today's visit was to follow-up on the issues that were present during the initial Pre-Licensing visit on August 13, 2024. The applicant requested to have a capacity of six (6), of which six (6) can be nonambulatory and of which one (1) may be bedridden. The facility is a one story house with an attached 2 car garage with four (4) bedrooms (1 is for staff), 2 bathrooms, dining room, a kitchen, and a living room. During a tour of the facility, LPA Kim observed that the following items have been corrected: 1) Backyard is clean and in good repair with the oranges removed. The facility will maintain weekly maintenance services to keep the backyard clean. 2) Left side gate door is operational by opening and closing. 3) The brick pathway has been replaced and is now stable. 4) Water temperature in the resident bathroom measured at 112.6 degrees Fahrenheit. 5) The facility has a tablet for the residents to use for internet access and for video conferencing purpose. All items have been corrected. The facility is ready for licensure. The pre-licensing visit and Component III Orientation are now complete. It appears this facility meets the requirements for licensure. LPA Kim will forward this report to the Centralized Applications Bureau for review. The license will be granted upon completion of a final review and approval from the Centralized Applications Bureau. An exit interview was conducted and a copy of this report was provided to applicant Mushaira Mosharrafthe state’s words, verbatim · CDSS document, Aug 23, 2024

Type of visit: Prelicensing

On August 13, 2024, at 1:00pm, Licensing Program Analyst (LPA) Edward Kim conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA Kim met with Applicants Mushaira Mosharraf and Shaira Mosharraf, and toured the facility. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to CCL on December 29, 2023. The facility is to have a capacity of six (6), of which six (6) can be nonambulatory and of which one (1) may be bedridden. Applicant has requested a hospice waiver for six (6) residents. Facility phone number (714)723-6746. LPA Kim observed the following. Structure: The facility is a one story house with an attached 2 car garage with four (4) bedrooms (1 is for staff), 2 bathrooms, dining room, a kitchen, and a living room. There are 4 exits: one exit door in the kitchen, one in the living room, one in the front door, and one in bedroom #3 which is the bedridden room. Air/Heating: Central air/heating system installed with a central panel to control entire house located in the hallway. Resident Bedrooms: There are three (3) Resident Bedrooms. The bedrooms are spacious and will easily accommodate the residents' belongings. All resident rooms had the required furnishings. Bedrooms Staff: There is one bedroom designated as the staff bedroom Evaluation Report Continues on LIC 809-C Bathrooms: All bathrooms have a working toilet, wash basin and shower. All bathrooms are clean. Linens & Hygiene Supplies: Adequate supply of linen stored in hallway cabinets. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed and posted in the hallway. Menus posted and available on the rerigerator. Menus prepared one week prior and listed for food served for one week. Food Service: There are no residents living in the facility at this time. There is 7-day non-perishable food supply on hand. The emergency food, emergency water, and emergency supplies are stored in the garage. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors are hardwired and tested operational. There is a fire extinguishers mounted on the wall in the kitchen. The fire extinguisher is fully charged. Appliances: There is one five (5) gas burner stove which lights unassisted, oven, microwave oven, a refrigerator, dishwasher, washer, and dryer. All appliances are clean and operational. Toxins: All cleaning supplies and chemicals are kept in two areas: kitchen cleaning supplies locked in the pantry and all extra cleaning supplies are locked in the garage.. Water Temperature: Hot water was measured in all bathrooms. Hot water measured between to 100.7 degrees Fahrenheit. Evaluation Report Continues on LIC 809-C Medications, First-Aid Kit & Book: The first aid kit and the first aid manual are stored in pantry in the kitchen. The first aid kit has all the required elements. Medications will be stored in the cabinet above the sharps, cleaning supplies, and first aid kit and first aid manual cabinet. The cabinets are kept locked. Resident & Staff Files: The Resident and Staff Records will be kept locked in filing cabinets located in the staff bedroom.. Reading Material, Games, Equipment & Materials: Books and board games are stored in the living room. There is a large screen TV in the living room. Fire clearance: Fire Clearance approved by Anaheim Fire Department on January 30, 2024. Component III: Component three During the pre-licensing inspection, LPA Kim observed the following items that must be corrected: 1) backyard needs to be clean by removing oranges on the ground, 2) left side gate door does not open/close as intended, 3) the brick pathway is not a stable walkway and could be a potential safety concern, 4) water temperature in resident bathroom did not measure between 105 degrees Fahrenheit and 120 degrees Fahrenheit. The water temperature measured at 100.7 degrees Fahrenheit, and 5) there is no tablet, computer, or laptop available for the residents to use for internet access. The applicant plans on making the necessary corrections and contacting LPA Kim to schedule a follow up pre-licensing inspection. Exit interview was conducted and a copy of this report was provided to applicants Mushaira Mosharraf and Shaira Mosharraf. LPA Edward Kim will submit a copy of the facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.the state’s words, verbatim · CDSS document, Aug 13, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Mosharraf, Mushaira and Mosharraf Shaira - Applicant/Administrator Interview Method: Virtual interview (Skype, Go To Meeting, etc) On 04/30/2024, 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, Apr 30, 2024