Ark's Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an annual inspection. LPA was greeted by caregiver who allowed LPA to enter. The Administrator Gamer Nazari was contacted and arrived to the facility during the inspection. LPA conducted a physical plant inspection of the inside and outside. Common areas: The living rooms and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature. Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. LPA observed an additional freezer used to store extra food located inside the garage. Knives/sharps were observed to be kept in a locked kitchen drawer. The cleaning solutions/toxins were observed to be kept locked in the garage and kitchen. Kitchen appliances were observed to be working and in proper condition. Bedrooms: The facility is a single-story building with (5) private bedrooms and (2) bathrooms. All rooms were appropriately furnished, with clean bedding and linens, and lighting system. LPA observed auditory signals in each room working and in proper condition. Rooms also have fall risk alarm on the floors of resident rooms. Each time a resident touch the floor with there feet, an alarm notifies staff which room and resident touched the floor. Hallways/passageways are lighted appropriately. Extra linens/covers were observed stored in multiple cabinets located in the laundry area. Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations at 120.0. LPA observed grab bars in the shower and by the toilet, with non-skid mats in the shower. Soap and towel are available. Laundry Room: The laundry room is located near the garage. The laundry appliances were observed to be working and in proper condition. Chemicals and household supplies are locked and secured. Garage: The garage can be accessed from inside of the facility and was observed to be kept locked. LPA observed cleaning solutions, toxins, and an extra freezer for food all stored within the garage and inaccessible to residents. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. There is swimming pool that was secured and inaccessible to residents. There were (2) exit gates. No obstruction and clear passageways. Medications: The medications were observed stored in a locked closet located with the hallway’s passageway. First-aid kit observed to be equipped. Smoke detectors and carbon monoxide observed to be working properly and were tested. Residents/Staff Records: LPA conducted a complete file review of resident records. Resident records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. Exit interview conducted and a copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Feb 10, 2026

Type of visit: Prelicensing

On 1/16/25, at 10:00 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an announced Pre-licensing visit. LPA Segovia met with Administrator Gamer Jim Nazari. An application was submitted to Community Care Licensing Division-CCLD on 06/20/2024, Initial license for a Residential Care Facility for the Elderly (RCFE), 60 years and older. The pending facility will have a Dementia Care Program. The requested capacity is for five (5) non-ambulatory and one (1) bedridden, total of up to six (6) residents, and Hospice waiver for six (6) residents. Fire clearance was approved on 11/14/2024. Structure: The facility is a single-story building with five (5) bedrooms and two (2) bathrooms. One (1) room will be designated staff room only. Entrance: There is only one (1) entrance being utilized. Required postings such as: Personal Rights of Residents, Rights of Resident by Council, Family Council, Infection Control, Emergency and Disaster Plan, Facility Sketch, Theft and Loss Policy, House Rules, Non-discrimination Policy and See Something Say Something are posted upon entry. Living/Dining area: The living room is neat, clean, and organized with sufficient seating for both residents and staff. The dining area is also neat, clean, and organized. Both rooms are properly furnished and in good repair. The facility maintains a comfortable temperature of seventy (70) degrees. No firearms observed or will be maintained on the premises. There is a working telephone on the premises. Fireplace: LPA observed fireplace covered and inaccessible to residents. Resident/staff files: Resident and staff files will be kept in the office located near the garage. Files will be kept in a locked cabinet inaccessible to Residents. First-aid kit observed as well. LIC809C-continued Kitchen: Sufficient supplies of dishes, cups, and silverware located within the kitchen cabinets and drawers. Sharps are stored in kitchen drawer locked and inaccessible to the residents. Sufficient supply of food such as: canned goods, bottles of water, cereal were observed. Kitchen appliances are working and in proper condition. Emergency: Fire extinguisher located upon entrance to the kitchen on the right side and dated 8/07/2024. Medications: Medication will be stored in a locked drawer in the kitchen. Medication storage is equipped with a lock to ensure medications will not be accessible to residents. Bedrooms: The bedrooms are properly furnished with bed, nightstand, applicable lightening, and seating. Window coverings are in good repair, not broken or damaged. LPA observed a signal systems in each bedroom windows, working and in proper condition. Bathroom: The bathrooms are in proper condition and will be equipped with sufficient personal hygiene for each resident. Towels and washcloths will not be shared. Appropriate grab-rails and slip-resistant mats observed and in proper condition. Hallways: Hallway is properly lighted. Extra linens/covers observed in storage cabinet within the passageway. The Garage: The garage can be accessed from inside the facility. It is kept locked. The garage will be used for extra storage, Cleaning solutions, Laundry detergents, extra food for emergencies, and extra personal hygiene supplies. There is an extra refrigerator and freezer. Both working and in proper condition. Laundry: Laundry is located inside the garage. Dryer and washer observed to be in good repair. Staff room: LPA observed designated staff room located near staff office. Staff room observed locked inaccessible to residents. Office: LPA observed staff reception office located near staff room. Water Temperature: The water temperature was measured in the bathrooms at 115 Fahrenheit and is within regulations. LIC809C-continued Smoke detectors: Dual interconnected smoke detectors and carbon monoxide observed to be working properly and were tested at 11:00 am. Outside: The outside is clean, free of hazards, and properly furnished with sufficient seating. A shaded area for residents was observed as well. Pool: Pool was observed to be fenced and locked inaccessible to residents. Administration: The facility had submitted a Emergency and Disaster Plan For Residential Care Facilities For The Elderly and Infection plan. Administrator: The Component III Orientation RCFE was shown/reviewed with the Administrator. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. Exit interview conducted and copy of this report issued to the administrator.the state’s words, verbatim · CDSS document, Jan 16, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: NAZARI, GAMER JIM - Licensee/Applicant Interview Method: Telephone interview On 11/19/2024, 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, Nov 19, 2024