American Senior Living

Type of visit: Required - 1 Year

On 03/10/26, Licensing Program Analysts (LPA) M. Yang arrived unannounced to conduct an annual visit. LPA introduce self, stated the purpose of the visit and met with staff Roxanne Chavez. All three residents were present during inspection. Licensee/Administrator (L1) Lina Juarez was called and arrived shortly during visit. LPA toured facility with L1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Fire extinguisher was observed with a service date of 02/24/26. Temperature maintained for refrigerator at 33 degrees F and freezer at -4 degrees F. Medications observed locked in kitchen shelf. MAR was reviewed. An adequate supply of perishable and non-perishable food was observed. Cleaning supplies observed stored under kitchen sink, under bathroom sink, in laundry room cabinet and garage cabinet locked. Extra linens observed in garage cabinets. All bedrooms were observed to have required furnishings and with adequate lighting. All bathrooms are observed with securely fastened grab bars and non-skid mats. Hot water tested maintained at 106.3 and 107.2 degrees F in vacant master bathroom and at 110.2 degrees F in hall bathroom. Outside of facility toured and observed to be free of debris. Adequate outdoor seating observed for residents. Side gate was observed free of debris. Carbon monoxide and smoke detectors were tested and observed to be operational during visit. All residents’ and sample of staff files were reviewed to have all required documents. A deficiency is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit Interview conducted. LPA received copies of Lic 308, Lic 500, Lic 610E, Lic 9020, current Administrator Certificate, and current liability insurance during visit. A copy of this report and appeal rights was provided to the Licensee, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Mar 10, 2026

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff spoke to resident in an inappropriate manner. Staff did not assist resident for an extended period of time.

On this date 12/22/25, Licensing Program Analyst (LPA) M. Yang conducted initial complaint investigation. LPA introduce self, stated the purpose of the visit, and met with Licensee/Administrator (A1) Lina Juarez and Licensee (L1) Shervin Mohammadi arrived shortly. LPA discussed complaint and delivered complaint findings to Licensees. During the course of the investigation, the Department conducted interviews and reviewed records. Staff and residents confirm staff did not speak to resident in an appropriate manner. Staff attended to resident needs when requested. Based on interviews conducted, staff alleged spoke to the resident in an appropriate manner and did not assist resident for an extended period of time, the preponderance of evidence has not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to Licensee/Administrator, whose signature on this form confirms receipt of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 22, 2025 · control 24-AS-20251219150428

Allegation investigated: Staff did not treat resident with respect

On this date, Licensing Program Analyst (LPA) M. Yang conducted initial complaint investigation. LPA introduce self, stated the purpose of the visit, and met with Licensee/Administrator (L1) Lina Juarez. Licensee (L2) Shervin Mohammadi arrived shortly. LPA discussed complaint and delivered complaint findings to Licensees. During the course of the investigation, the Department conducted interviews and reviewed records. L1 confirmed making comments regarding R1. Based on interviews conducted, staff alleged not treating resident with respect, the preponderance of evidences has been met. Therefore, the above allegation is found to be SUBSTANTIATED. An exit interview was conducted. A copy of this report and appeal rights were provided to Licensee/Administrator, whose signature on this form confirms receipt of this report. Substantiatedthe state’s words, verbatim · CDSS document, Nov 4, 2025 · control 24-AS-20251029100138

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Nov 5, 2025

87468.1 (a)(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by: Based on interviews conducted, the licensee did not comply with the section cited above Licensee/ Administrator confirmed making comments regarding R1 of R1’s behavior, which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 4, 2025

Plan of correction: Licensee will review Personal Rights regulation and submit a written statement of understanding and ensuring residents’ personal rights will be met. Written statement will be submitted to the Fresno CCL office by POC due date 11/05/25.

Type of visit: Case Management - Deficiencies

On 11/04/25, Licensing Program Analyst (LPA) M. Yang conduct an unannounced case management-deficiency visit. LPA met with Licensee/Administrator (L1) Lina Juarez and Licensee (L2) Shervin Mohammadi. This case management visit is being conducted due to during complaint visit, staff and residents’ files were reviewed and staff training was not observed for S1. L1 informed LPA, R1 had a fall incident on 10/25/25 and was not reported to the department. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6.An exit interview was conducted. A copy of this report and appeal rights was provided to L1, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Nov 4, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c) · Plan of correction due date: Nov 21, 2025

87412 (c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above when LPA reviewed S1’s file and observed S1 have not received the required initial staff training and orientation, which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 4, 2025

Plan of correction: Licensee shall ensure that all staff have required trainings and continued trainings recorded. Licensee will submit S1’s required training including trainer’s full name, subject covered in the training, date of the training, number of hours of training per subject to the Fresno CCL office by POC due date 11/21/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(D) · Plan of correction due date: Nov 7, 2025

87211 (a)(1)(D) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events…(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidenced by: Based on record review and interview conducted, Licensee did not submit a written report to the department within 7 days of incident when R1 had a fall on 10/25/25, this poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 4, 2025

Plan of correction: Licensee will submit review Reporting Requirements regulation 87211 and submit a plan detailing steps the facility will take to ensure Reporting requirements are met by the POC due date 11/07/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(b)(17) · Plan of correction due date: Nov 10, 2025

87506 (b)(17) Documents and information required… This requirement is not met as evidenced by: Based on record review, residents’ file were reviewed and observed R1 do not have an appraisal (Lic 603) and needs and services plan (Lic 625) on file, which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 4, 2025

Plan of correction: Licensee shall ensure that all residents have the required records on file. R1’s Lic 603 and Lic 625 will completed and submitted the Fresno CCL office by POC due date 11/10/25.

Type of visit: Required - 1 Year

On 03/18/25, Licensing Program Analysts (LPA) M. Yang arrived unannounced to conduct an annual visit. LPA introduce self, stated the purpose of the visit and met with Licensee/Administrator Lina Juarez and staff Shervin Mohammadi. All four residents were present during inspection. LPA observed three hospice residents and one non ambulatory resident. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Fire extinguisher was observed with a service date of 02/24/25. Temperature maintained for refrigerator at 37 degrees F and freezer at -4 degrees F. Medications observed locked in kitchen shelf. Medications checked and MAR was reviewed. An adequate supply of perishable and non-perishable food was observed. Cleaning supplies observed stored under kitchen sink, in laundry room cabinet and garage cabinet locked. All bedrooms were observed to have required furnishings and with adequate lightening. Bathrooms were properly equipped and operational. All bathrooms are observed with securely fastened grab bars and non-skid mat. Extra linens observed in garage cabinets.Outside of facility toured and observed to be free of debris. Adequate outdoor seatings observed for residents. Side gate observed free of debris. Carbon monoxide and smoke detectors were tested and observed to be operational. All residents’ and sample of staff files were reviewed to have all required documents. No deficiencies issued during this inspection. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 03/24/25. Forms requested: Lic 308, Lic 500, Lic 610E, and current liability insurance. A copy of this report were provided to the Licensee, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Mar 18, 2025

Type of visit: Case Management - Deficiencies

On 03/19/25, Licensing Program Analyst (LPA) M. Yang arrived to conduct a case management-deficiency visit. LPA met with Licensee/Administrator (L1) Lina Juarez and staff(S1) Shervin Mohammadi. During the annual inspection on 03/18/25, LPA reviewed residents record and conducted interviews. L1 and S1 stated R1 had went to the hospital on 02/13/25 and 02/25/25 and was not reported to the department Records were reviewed and confirmed resident to the hospital. Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. An exit interview was conducted. A copy of this report and appeal rights was provided to Licensee, whose signature confirms receipt of this report.the state’s words, verbatim · CDSS document, Mar 18, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Mar 21, 2025

87211(a)(1) Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require… (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events... This requirement was not met as evidenced by: Based on record review and interviews, the Licensee did not ensure a written incident report was submitted to the department within 7 days of occurrence when R1 went to the hospital on 02/13/25 and 02/25/25, this poses/posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 18, 2025

Plan of correction: Licensee agrees to submit a plan detailing steps the facility will take to ensure the requirements of Reporting requirements are met by the POC due date 03/21/25.

Type of visit: Prelicensing

On 04/19/24, Licensing Program Analyst (LPA) Yang arrived to the facility announced to conduct the Pre licensing visit. LPA Yang met with Licensee Lina Diaz Juarez and Licensee’s spouse Shervin Mohammadi who granted LPA entry into the facility. The facility is a 5 bedroom, and 3 bathroom home and fire clearance were granted for 3 Ambulatory and 3 Bedridden for a total capacity of 6. A fire extinguisher was observed with a service date of 01/17/24. There are no clients present during this inspection. LPA toured the facility with Licensee. Facility was free from ground obstructions and odor free. Common areas were observed to have adequate seating and lighting available. Kitchen was toured and observed to have dishes, plates, and utensils. Knives kept locked in kitchen drawer. Refrigerator temperature maintained at 39.2 degrees F and freezer temperature maintained at 0 degrees F. Medications will be kept locked in kitchen shelf. Cleaning supplies and chemicals was locked in a garage cabinet. LPA observed an extra supply of bed linens and personal hygiene products. Bedrooms were observed to have the required furnishing and are ready for occupancy. Bathroom 1 hot water temperature tested at 109.6 degrees F, ranged between 107.4 to 108.1 degrees F in master bathroom, and 110.7 in private bathroom. Outside of facility toured. Exits were open and free of obstructions with self-closing side gate. Adequate outdoor seatings available for residents. LPA observed side gate to be self-latching and free of debris. First aid kit was observed and contained all required items. Smoke detectors and carbon monoxide were observed to be operational during this inspection. Facility phone number will be (661) 493-8209. Component III was conducted during pre-licensing visit with Applicants. I have found that applicant has met all pre licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.the state’s words, verbatim · CDSS document, Apr 19, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: JUAREZ, LINA F DIAZ - Applicant/Administrator Interview Method: Virtual interview (Skype, Go To Meeting, etc) On 03/21/2024, 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, Mar 21, 2024