Daisy Springs Residential Care

Type of visit: Required - 1 Year

On 07/16/2026 at 9:00 AM, Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with staff/caregiver Rani Kaur and was granted entry to the facility. Licensee/Administrator Mehrunnisa A Latif was contacted, arrived during the visit and LPA Singh explained the purpose of this visit. The facility is Residential Care Facility for the Elderly (RCFE). six (6) four(4) non-ambulatory and two(2) bedridden residents. Waiver granted for six(6) Hospice care residents on 06/11/2025. Fire clearance was granted on 04/08/2025. The current census is Five(5)residents, Staff informed LPA Singh that One(1) resident passed away on 07/29/2026, resident was on hospice services. LPA was accompanied by Staff to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 73 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperature in a resident bathroom to be in regulations. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguishers were also observed at the facility. Posters such as personal rights, the CCLD complaint poster, Ombudsman poster, labor laws were posted in a common area. ***Continuation in LIC809C *** Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine cabinet for the residents’ medications locked. Food Service: More than seven (7) days’ supply of non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The facility has sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA Singh reviewed five (5) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. No issues observed. LPA reviewed two(2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings with Tuberculosis (TB) Test Result. No issues observed. Medications/Medication Administration Record (MAR) were audited for five (5) residents. No issues observed. Based on the observations made during today’s visit, no deficiencies nor advisories issued per Title 22, Division 6, of the California Code of Regulations. Fire drill was conducted on 06/18/2026 and Earthquake drill was conducted on 05/14/2026. Liability Insurance valid from 10/30/2025 to 10/30/2026. Annual fees is current. An exit interview was conducted, and this report (LIC809), was discussed and provided to Mehrunnisa Latif, Facility Licensee/Administrator.the state’s words, verbatim · CDSS document, Jul 30, 2026

Type of visit: Prelicensing

On 06/30/2025 at 12:45 pm Licensing Program Analyst (LPA) Beena Singh conducted an announced visit to the facility for the purpose of a Pre-Licensing evaluation. LPA Singh met with Administrator Mehrunnisa Latif. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 03/25/2025 for a total capacity of six (6) four(4) non-ambulatory and two(2) bedridden residents. Waiver granted for six(6) Hospice care residents on 06/11/2025. Fire clearance was granted on 04/08/2025. LPA observed the following: Structure: The facility is a one(1) storey house with four (4) bedrooms two (2)resident bathrooms, living room, dining area and kitchen. There was an attached three car garage on the left side of the house. Heating /Cooling System: Central heating and air conditioning system installed with a control panel located at the back of the facility. Bedrooms: Bedrooms 2,3,4 will accommodate non-ambulatory residents and bedroom one (1) will accommodate bedridden residents are adequately furnished with bed, closet, appropriate linens and adequate lighting. Night lights were observed in the facility and will be placed in the hallways leading to residents' shared bathrooms. Bathrooms: There is a staff bedroom with bathroom and there are two (2) bathrooms for the residents which have working toilets, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. The water temperature was measured at 110 degrees Fahrenheit in the resident’s bathroom. Kitchen: The kitchen has an adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives and knives were secured in a locked drawer located in the kitchen. There was an adequate room for food storage. LPA observed the stove to be operational. Refrigerator(s)/freezer(s) were in working condition. There was sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry: Laundry room with washer and dryer. Laundry detergents and cleaning supplies will be locked in the laundry room, which can be locked from exterior door. Living /Family Room: There was a living/family room with a TV and adequate seating for all residents. Linens and Hygiene: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outdoors: There is sufficient covered seating area the backyard. The gate on the right side is the exit and is self-latching. All outdoor pathways were free of obstructions. Emergency Phone Numbers and Exit Plan: Facility sketches were observed posted in the main living room area. There were two(2) fire extinguishers and two(2) carbon monoxide detectors and five(5) smoke detectors which are working and in good condition. General items: Client records will be stored in a locked cabinet.. First Aid kit with required components is located in the dining room cabinet. Personnel files and medication will be locked in the cabinet. LPA observed a facility phone- 909-320-7320 and it was verified to be operational. Emergency water supply and food were observed. The facility has met the requirements according to Title 22 regulations and is ready for licensor. An exit interview was conducted, no deficiencies were cited, Component III was completed during this visit, and a copy of this report was reviewed and provided to Administrator Mehrunnisa Latif.the state’s words, verbatim · CDSS document, Jun 30, 2025

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: MEHRUNNISA LATIF Interview Method: Telephone interview On May 20, 2025, 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 the understanding of the California Code Title 22 Regulations. 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. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, May 20, 2025