Carmel Oaks Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 10 a.m. Upon arrival, LPA Mosley was greeted by staff and acting Administrator, Lady Grace Dimpilis Cobam and the reason for the visit was explained. Entrance interview. The LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility is a double-story home located in a residential neighborhood.COMMON AREAS: This includes the living room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 1:09 p.m., hardwire combination of smoke / carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 07/18/2025. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 04/20/2026 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. There is a functioning telephone on the premises. Auditory alarms at the entrances and exits were observed and functional at the time of the visit. LPA observed surveillance cameras installed in the common areas of the facility. The Administrator presented the live monitoring screen to the LPA, confirming that all cameras were functioning properly and that none of them were equipped with audio capability. INTERVIEWS: Starting at 10:52 and throughout the visit LPA conducted two (2) staff and three (3) resident interviews. Staff interviews revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interview revealed that no concerns were noted or voiced at the time of the visit. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... BEDROOMS: There are nine (9) total bedrooms in the facility; four (4) bedrooms are designated resident rooms of which two (2) are shared, double occupancy and two (2) are private, single occupancy, resident rooms and five (5) staff rooms. The staff rooms are kept locked at all times and observed to be occupied by staff. All passageways were observed to be clear of obstructions. All rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen, which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All rooms were free of odors. All window screens were clean and maintained in good repair. Each bedrooms have its own supply of linens stored in the closet. RESTROOMS: There are six (6) total restrooms. Two (2) are designated as a shared / common resident restrooms. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 119.1-120 degrees Fahrenheit, all within the required range. LPA advised the Administrator of the regulatory standard of 105-120 degrees Fahrenheit, as the water temperature was at the maximum. LPA observed storage space closets in the hallway containing extra clean linens and towels for resident use. KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. Cleaning supplies and other chemicals are kept under the sink locked and inaccessible to residents in care. BACKYARD: The entire property is fenced. The backyard has a covered patio area with shade, patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. There is a small locked storage shed in the back yard inaccessible to residents. Only one (1) pathway is used as an emergency exit which was free of obstructions at the time of the visit. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... GARAGE: LPA observed the facility garage, which was locked and contained emergency food and water, a storage room containing emergency supplies, an extra refrigerator/freezer that were checked for proper labels and expiration dates. LPA observed washer, dryer and detergent. RECORDS: Resident Records were reviewed beginning at 11:21 a.m. Six (6) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, Home Health records, Hospice records, PRN authorization letters, and current needs and services plan. All records were in order. Personnel Records Four (4) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. At the time of the visit LPA was presented with all the required documentation for an Administrator change that was submitted to Licensing on 01/26/2026. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required 05/07/2026. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. MEDICATIONS: Medication review began at approximately 12:58 p.m. Medications are centrally stored and locked upstairs in room #8. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were properly documented on the centrally stored medications and destruction record, stored, locked and inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed. No errors observed during review. LPA observed the first aid supplies to be complete, including sterile first aid dressings, bandages, tweezer, a thermometer and a current version of a first aid manual. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster and LIC 9020A Resident roster and copy of the Limited Liability insurance. At the time if the visit the LPA reviewed the facilities contact information on file including phone numbers, email and annual fees. Administrator made a chnage to the mobile number and confirmed that all information is accurate. No citations issued at this time. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, May 29, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility today to conduct a required annual visit. The LPA met with Administrator/Operator Nirvana Ghaemi, and explained the reason for the visit. The LPA, and the Administrator toured the physical plant areas at approximately 10:40 a.m. inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Fire extinguisher last serviced 05/16/2024. BEDROOMS: The resident bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are three bedrooms for resident use; room#3 and room #4 are designated staff room. Rooms #1, #2, #5 and #6 are designated resident rooms. RESTROOMS: Residents’ restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Proper hygiene products and paper products are available for use. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable food and non-perishable food; knives, sharps observed stored in a locked cabinet drawer; clean supplies also observed locked under kitchen sink cabinet. The facility maintained a temperature of 75 degrees. All exits have functioning auditory devices. Required postings observed in the kitchen and hallway area. The backyard has a covered outdoor area equipped with furniture for resident use. The side gate door is self-latching. There were no bodies of water noted. The garage is detached from the home and kept locked. Laundry machine and detergents observed in the locked garage. (Continue to LIC809c). RESIDENTS' records review began at 11:30 a.m., records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. STAFF records review began at 12:45 p.m., records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 2:30 p.m. Medications are centrally stored and locked in a cabinet in staff room #4. Medications were labeled and checked for expiration dates. Medications are properly documented on the Centrally Stored Medication & Destruction Record (LIC 622)..Two residents’ medications were audited and found to be in order. All medications were logged, contained all required fields. Administrator did not have a PRN Authorization letter on file for resident #2 and resident #3. INFECTION CONTROL: Staff are following facility's infection control plan; maintaining cleanliness and disinfecting/sanitizing facility daily. . The LPA requested administrator to submit an updated LIC500 Personnel Report and current liability insurance be sent to CCL by 05/9/2025. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview was conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 6, 2025

The state marks this report as 13 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 2:00 p.m., the LPA met with staff and explained the reason for it visit. At 2:50 p.m., the Administrator arrived at the facility. At 2:41 p.m., the LPA, along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 2:45 p.m., hot water measured within required range. BEDROOMS: The facility is a two-story residential home with nine (9) bedrooms, four (4) for resident use and five (5) for staff use. The residents do not go to the 2nd floor. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. Medications are stored in a locked cabinet inside staff room #4. RESTROOMS: The facility has six (6) bathrooms, three (3) for resident use. Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid materials. Starting at 12:39 p.m., hot water measured between 105.0 and 111.6-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. OUTDOOR SPACE: At 3:05 p.m., the LPA observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. The garage is detached and remains inaccessible to residents. Passageways were free and clear from obstruction. There are no bodies of water on the premises. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguishers to be fully charged and last serviced on 05/16/2024. At 2:58 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Night lights were present in the hallways and passages. Due to time constraints the LPA will return to complete the annual at a later date. No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, May 22, 2024