Comfort Zone Cal

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted staff and explained the reason for the visit. The staff contacted the Administrator Stmaltzin Torres Malaga and informed them of the visit. The administrator stated that they would arrive soon, however at 1:02 p.m. the Administrator had not arrived, consequently the LPA called and sent a text to the Administrator. Still no reply. The LPA then reached out to the Licensee at 1:15 p.m. to inform them that the Administrator failed to arrive at the facility for the annual inspection and failed to respond to call and text. The Licensee stated that it would take them approximately 45 mts to arrive at the facility. The LPA stated that they would wait for them. The LPA, along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. The facility is a single-story residential home with five (5) bedrooms, four (4) for resident use and one (1) for staff use and two (2) bathrooms. COMMON SPACES: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The three (3) fire extinguishers were fully charged and purchased on 02/03/2025. The LPA observed required postings by the main entrance. The facility has a designated area as office space, adjacent to the dining room; the residents’ and staff files are locked in a file cabinet. Medications are locked in a file cabinet in the office area as well. KITCHEN: Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility had a sufficient supply of perishable and non-perishable food. Hot water measured 146.1 degrees Fahrenheit. LAUNDRY AREA: Is located behind locked cabinet in the hallway leading to the bedrooms. Continues on LIC 809C... BEDROOMS: The bedrooms appeared to be clean and furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bedroom #1 lacks closet space. Bedroom #2 closet needs to be clean of clutter. RESTROOMS: Resident restrooms appeared to be clean and sanitary condition with bars and non-skid surfaces. The hallway bathroom wall needs repair on the bottom of the wall next to the shower area, as it has a small open area (hole). The bathroom sink needs to be de-clogged as the water was left standing after letting the water run for about two (2) minutes and draining very slowly. Bathroom #2 inside room #4 when flushed appeared to be clogged. The hot water temperature tested at 143.6-degrees Fahrenheit. OUTDOOR AREA: The LPA observed the backyard, which has a covered outdoor area for resident use. The LPA observed a fenced swimming pool with a self-latching gate with a lock. At the time of the visit, the emergency exit was free and clear of obstruction. RECORDS: Records review began at 12:00 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. One staff file did not have the required training's, CPR/first Aid, and Health assessment. MEDICATIONS: Medications review begin at 1:57 p.m.; medications are centrally stored and locked in a cabinet in the office area. The medications are documented properly on the centrally stored medications and destruction record, however the medication count for three medications were incorrect. Eye drops for one resident had been exhausted, when in fact there should have been three days of medication still available in the eye drops bottle, furthermore, the eye drop bottle was missing. A second medication metoprolol/50mg tablet packet had quantity as 14 pills per packet however the LIC 622 had documentation of 30 pills. Atorvastatin had one pill left in the packet, when the pills should have been exhausted as of today’s visit. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Certificate of Liability of Insurance _ Emergency Drill Logs Citations were issued. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 8, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. The LPA met with staff and explained the reason for the visit. The staff contacted the Administrator John Jason Eugenio and the Licensee Akhtar Roshanaeian. The LPA spoke with both, the Administrator and the Licensee on the phone and explained the reason for the visit. Due to inclement weather and personal reasons, neither was present at the time of the visit. The LPA told both administrators that it would be ok for them to be away during the visit, since the LPA would only be able to conduct the physical plant inspection due to time constraints. LPA told the Licensee that they would call the Licensee if any urgent matters were visible during the physical plant inspection. The Administrator and the Licensee agreed to allow the staff to sign the report on their behalf. At 1:32 p.m., the LPA, along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. The facility is a single-story residential home with five (5) bedrooms, four (4) for resident use and one (1) for staff use and two (2) bathrooms. COMMON SPACES: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The two (2) fire extinguishers were fully charged and purchased on 02/03/2025. The LPA observed required postings by the main entrance. The facility has a designated area as office space, adjacent to the dining room; the residents’ and staff files are locked in a file cabinet. Medications are locked in a file cabinet in this are as well. KITCHEN: Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility had a sufficient supply of perishable and non-perishable food. At 1:51 p.m., hot water measured at 107.3-degree Fahrenheit. Continues on LIC 809C... BEDROOMS: The bedrooms were observed to be clean and furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. The hot water temperature tested between 108.4- and 112.4-degree Fahrenheit. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single-latched. The washer and dryer are located in the… Cleaning supplies and disinfectants are kept in locked cabinets in the…. Due to time constraints the LPA will return to complete the annual at a later date. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 5, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 1:06 p.m., the LPA met with staff and explained the reason for the visit. At 2:17 p.m., the Administrator, John Eugenio arrived at the facility. At 4:00 p.m., the Licensee, Akhtar Roshanaeian arrived at the facility. At 1:32 p.m., the LPA, along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. The facility is a single-story residential home with five (5) bedrooms, four (4) for resident use and one (1) for staff use and two (2) bathrooms. KITCHEN: The LPA observed the kitchen and dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility does not have sufficient supply of perishable and non-perishable food. The Licensee stated that she goes grocery shopping once a week. At 1:51 p.m., hot water measured at 107.3-degree Fahrenheit. BEDROOMS: 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. RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Starting at 1:46 p.m., the hot water temperature tested between 108.4- and 112.4-degree Fahrenheit. COMMON SPACES: At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the fire extinguishers to be fully charged and last purchased on 01/27/2024. During the time of the visit, the LPA observed two (2) smoke alarms/ carbon monoxide detectors beeping indicating that a change of batteries is needed. Continued on LIC 809-C. OUTDOOR SPACE: The LPA observed the backyard, which has a covered outdoor area for resident use. The LPA observed a fenced swimming pool with a self-latching gate with a lock. At the time of the visit, the emergency exit was free and clear of obstruction. At 1:39 p.m., the LPA observed a hole on the back-patio ramp. At the time of the visit, two (2) out of four (4) residents (Resident #1, Resident #2) were identified as bedridden per their medical assessment. However, R1 is not in the identified bedridden room. Additionally, per the fire clearance, the facility can only have one (1) bedridden resident at a time, whom can only reside in Bedroom #1. An immediate civil penalty of $500 is assessed, due to a violation of the fire clearance. Starting at 1:53 p.m., the LPA conducted interviews with one (1) resident and two (2) staff. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8 and California Health and Safety Code the following deficiencies were cited (refer to LIC 809-D). The Licensee and Administrator were made aware that failure to correct the deficiencies may result in additional civil penalties. Due to time constraints the LPA will return to complete the annual at a later date. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 27, 2024

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced Case Management - Deficiencies inspection. At 10:55 a.m., the LPA met with staff and explained the reason for the visit. At 12:34 p.m., the Licensee Akhtar Roshanaeian arrived at the facility. The reason for today's inspection is to follow up on a self-reported incident dated 10/18/2023. The report pertains to the absent without official leave (AWOL) of Resident #1 (R1). On 10/17/2023, R1 left the facility despite caregivers attempting to redirect R1. The Administrator at the time notified R1’s family and the police. At the time of the visit, R1 still has not been located but the family are aware of the AWOL. At 11:30 a.m., the LPA conducted a record review of resident records. At 1:30 p.m., the LPA, along with the Licensee conducted a brief physical plant tour. During the time of the visit, the LPA requested copies of pertinent documents. Prior to visit, the LPA printed out the facility personnel report summary from the Licensing Information System (LIS). Upon arrival, it was revealed Staff #1 (S1) was recently hired. Per record review, conducted by the LPA on the Guardian Background Check System website, S1 does have fingerprint clearance but is not associated with this facility. Interviews with the Licensee and staff revealed that S1 started working at this facility on 11/01/2023. The Licensee stated that she will ensure that all staff will have a criminal record clearance and are associated to the facility prior to working at the facility. During record review the following was noted: R1, Resident #2 (R2), Resident #3 (R3) and Resident #4 (R4) did not have resident files nor completed files available at the facility. Per incident report, R1 was admitted to the facility on 10/10/2023. R2 was admitted to the facility on 09/12/2023, R3 was admitted to the facility on 09/15/2023 and R4 was admitted to the facility on 10/31/2023. The Licensee stated that she will ensure that all residents will have completed files. Continued on LIC 809-C. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiencies were cited (refer to LIC 809-D). Civil Penalties assessed in the amount of $100. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. A copy of today's reports and appeal rights were provided. Civil penalties issued. An additional report may follow if warranted.the state’s words, verbatim · CDSS document, Nov 1, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Nov 2, 2023

87355(e)(2) Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health… shall prior to working... in a licensed facility: (2) Request a transfer of a criminal record clearance as specified... This requirement is not met as evidenced by: Based on record review and interview the Licensee did not comply with the section cited by not transferring the criminal record clearance for S1 to this facility prior to employment which poses an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 1, 2023

Plan of correction: Licensee agreed to submit a transfer of a criminal record clearance for all staff not associated to the facility by 11/02/2023. Civil Penalties assessed in the amount of $100.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(a) · Plan of correction due date: Nov 17, 2023

87506(a) Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility…readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as there were no files or incomplete files present at the facility for R1, R2, R3 and R4 which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 1, 2023

Plan of correction: The Licensee stated that she will ensure that all residents will have completed files by due date.