Eliaa

Type of visit: Required - 1 Year

On 03/25/2026, 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 Facility Staff-Marisela Figueroa and was granted entry to the facility. At the time of the visit there was one (1) staff present, and Three (3) residents present. Three(3) residents were out in the community. Facility Manager Amirr Younes arrived during the visit. LPA explained the purpose of the visit to Facility Manager Amirr Younes. The facility is a nine (9) bedroom, three (3) bathroom home with a kitchen/dining area, living room, activity room and laundry area. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) can be non-ambulatory residents. The facility has two (2) Hospice Waiver. The current census is two (2) residents. Four residents were out in the community for Innovage and other 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). LPA observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 72 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, and storage space, lamps, and chair. Moreover, LPA observed that bathrooms were clean, and appliances were operating appropriately. LPA observed grab bars and non-skid mat in the resident bathrooms. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCLD complaint poster, Ombudsman poster and the disaster plan were posted in a common area. ***Continuation in LIC809C *** LPA observed cleaning solutions, bleach locked in the cabinet and not accessible to residents in care. There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the medication room. Food Service: Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator and house manager. LPA observed sufficient number of staff to provide care and supervision to the residents in care. LPA reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. Medication Audit were completed for three (3) residents, no issues. LPA Singh reviewed two(2) staff files for criminal background check, Health screening, Tuberculosis(TB) test result, Required training, CPR. First Aid Certification. no issues. Liability Insurance valid through 09/26/2025-09/26/2026. Fire Drill conducted on 12/30/2026. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC 809 C were discussed and provided to House Manager Amirr Younes.the state’s words, verbatim · CDSS document, Mar 25, 2026

Allegation investigated: Staff do not ensure resident's hygiene needs are being met.

On 10/09/2025 at 9:00 AM Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility in order to initiate and deliver findings for the above allegations. LPA discussed the purpose of the visit with Facility House Manager/Licensee Ahmed Qasim. The investigation consisted of interviews, record review and observation. During the visit there were four residents in the facility and one(1) resident was out in the community. In regard to the allegation that Staff do not ensure resident's hygiene needs are being met. LPA interviewed two (2) staff and four (4) residents.Two (2) out of two(2) Staff stated that resident#1 does not like to take showers and staff has tried to assisted the resident#1with shower and change of clothes, but R#1 consistently refuses and R#1 is non complaince with house rules. Staff denied the allegation that staff do not ensure residents's hygiene needs are being met. Residents stated that staff assist them with showering and hygiene needs and Three(3) out of four(4) residents denied the allegation that staff do not ensure residents hygiene needs are being met. Unsubstantiated Based on the evidence found during the investigation, LPA Singh found the allegation: Staff do not ensure resident's hygiene needs are being met listed above to be Unsubstantiated. Unsubstantiated: A finding that the complaints are Unsubstantiated means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiency were cited during this visit. An exit interview was conducted, and this report LIC 9099, LIC9099C was discussed and provided to Facility Facility-House Manager/Licensee Ahmed Qasim.the state’s words, verbatim · CDSS document, Oct 9, 2025 · control 56-AS-20250930150930

Allegation investigated: Facility staff is financially abusing resident.

On 04/2/2025 at 12:45 PM Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility to deliver findings for the above allegations. LPA discussed the purpose of the visit with Facility House manager/Administrator Amirr Younes. The investigation consisted of interviews and record reviews about the allegation that Facility staff is financially abusing resident: LPA Singh interviewed five (5) clients and according to five (5) out of five (5) clients, Facility staff is not financially abusing them. R1 denied that staff is financially abusing R1. R1's finances are managed by R1 and family. The family member interviewed confirmed that R1's finances are managed by them and denied any concerns with the facility or its staff financially abusing R1. LPA conducted two (2) separate interviews with R1. Staff denied that the facility is financially abusing residents. Unsubstantiated Based on the evidence found during the investigation, LPA Singh found the allegations listed above to be Unsubstantiated. Unsubstantiated: A finding that the complaints are Unsubstantiated means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted, and this report LIC 9099, LIC9099C were discussed and provided to Facility House manager/Administrator Amirr Younes.the state’s words, verbatim · CDSS document, Apr 2, 2025 · control 56-AS-20250219144802

Type of visit: Required - 1 Year

On 04/2/2025 at 09:00 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 Facility Staff-Marisela Figueroa and was granted entry to the facility. At the time of the visit there was one (1) staff present, and Two (2) residents present. Facility Manager Amirr Younes arrived during the visit. LPA explained the purpose of the visit to Facility Manager Amirr Younes. The facility is a nine (9) bedroom, three (3) bathroom home with a kitchen/dining area, living room, activity room and laundry area. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) can be non-ambulatory residents. The facility has two (2) Hospice Waiver. The current census is two (2) residents. Four residents were out in the community for Innovage and other 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). LPA observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 72 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, and storage space, lamps, and chair. Moreover, LPA observed that bathrooms were clean, and appliances were operating appropriately. LPA observed grab bars and non-skid mat in the resident bathrooms. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCLD complaint poster, Ombudsman poster and the disaster plan were posted in a common area. ***Continuation in LIC809C *** LPA observed cleaning solutions, bleach locked in the cabinet and not accessible to residents in care. There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the medication room. Food Service: Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator and house manager. LPA observed sufficient number of staff to provide care and supervision to the residents in care. LPA reviewed two (2) resident files for admission agreements, updated physician reports, and needs and services plans. Medication Audit were completed for two (2) residents, no issues. LPA Singh reviewed two(2) staff files for criminal background check, Health screening, Tuberculosis(TB) test result, Required training, CPR. First Aid Certification. no issues. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC 809 C were discussed and provided to House Manager Amirr Younes.the state’s words, verbatim · CDSS document, Apr 2, 2025

Type of visit: POC

On 04/04/2024 at 11:45 AM, Licensing Program Analysts (LPAs) Melody Brown and Sarina Ramirez conducted an unannounced visit to the facility in order to verify clearance of plans of correction created with Licensee/House Manager Ahmed Qasim, from visit on 03/21/2024. LPAs Brown and Ramirez met with Administrator Amirra Younes. Licensee/House Manager Ahmed Qasim was contacted and arrived during the visit. The following Plan of Correction (POC)s were cleared at the time of the visit: The Licensee was cited on 03/21/2024 for 87355(e)(1) Criminal Record Clearance for allowing two (2) individuals to live at the adjacent two-storey building located at the back of the facility compound without criminal background clearance since 01/05/2024 which poses an immediate health, safety or personal rights risk to persons in care. Based on observation on 03/21/2024 and 03/25/2024, Licensee continued to allow the two (2) individuals to live at the adjacent two-storey building located at the back of the facility compound without criminal background clearance. The plan of correction (POC) was to obtain S5 Criminal Record Clearance. Therefore, POC was not cleared, and Civil penalty will be assessed in the amount of $100 per day for four (4) days. On 03/26/2024, Licensee Qasim submitted the criminal background clearance of the two (2) individuals that live at the adjacent two-storey building located at the back of the facility. LPAs Brown and Ramirez provided a clearance letter for this deficiency during the visit. The Licensee was cited on 03/21/2024 for HSC 1569.618(c)(3) Other Provisions. On 03/26/2024 Licensee Qasim submitted Staff #3 (S3) CPR and First Aid Training. LPAs Brown and Ramirez provided a clearance letter for this deficiency during the visit. The Licensee was cited on 03/21/2024 for 87412(g) Personnel Records. On 03/22/2024, Licensee Qasim submitted proof of Personnel Records maintained at the facility. LPAs Brown and Ramirez provided a clearance letter for this deficiency during the visit. *** Continuation in LIC809C *** The Licensee was cited on 03/21/2024 for CCR 87412(a)(11). On 03/26/2024, Licensee Qasim submitted proof of completed Staff #5 (S5) Health Screening Report with a Physician. LPAs Brown and Ramirez provided a clearance letter for this deficiency during the visit. The Licensee was cited on 03/21/2024 for CCR 87412(a)(12) Personnel Records. Licensee Qasim submitted proof of Staff #5 negative Tuberculosis (TB) Test Result on 03/26/2024. LPAs Brown and Ramirez provided a clearance letter for this deficiency during the visit. The Licensee was cited on 03/21/2024 for CCR 87456(a)(2) Evaluation for Suitability for Admission. Licensee Qasim submitted proof of completed Resident #2 (R2) Pre-placement Appraisal on 03/26/2024. LPAs Brown and Ramirez provided a clearance letter for this deficiency during the visit. The Licensee was cited on 03/21/2024 for CCR 87456(a)(3) Evaluation of Suitability for Admission. Licensee Qasim submitted proof of updated Physician Report (LIC602) for Resident #3 (R3) on 03/31/2024. LPAs Brown and Ramirez provided a clearance letter for this deficiency during the visit. The Licensee was cited on 03/21/2024 for HSC 1569.69(a)(2). Licensee Qasim submitted proof of Staff #5 (S5) Training Log on 03/26/2024. LPA Brown and Ramirez provided a clearance letter for this deficiency during the visit. An exit interview was conducted and this report, LIC809 along with Civil Penalty Assessment pages, and Appeal Rights were reviewed and provided to Licensee/House Manager Ahmed Qasim.the state’s words, verbatim · CDSS document, Apr 4, 2024

Type of visit: Case Management - Other

On 03/25/2024 at 01:30 PM, Licensing Program Analyst (LPA) Melody Brown made an announced visit to the facility to amend the forms LIC809C, LIC809D and LIC421BG issued on 03/21/2024 due to incorrect amount on Civil Penalty Assessment Issued. LPA Brown met with House Manager/Licensee Ahmed Qasim and was granted entry to the facility. At the time of the visit there's two (2) staff present, and six (6) residents present. During this visit, LPA Brown amended the forms LIC809C, LIC809D, LIC421BG issued on 03/21/2024 due to incorrect amount on Civil Penalty Assessment Issued for two (2) individuals living at the adjacent two-storey building located at the back of the facility compound without criminal background clearance since 01/05/2024 which poses an immediate health, safety or personal rights risk to persons in care. Civil Penalty of $500.00/per individual will be assessed today, 03/25/2024. An exit interview was conducted, and this report (LIC809), and amended copies of LIC809C, LIC809D, LIC421BG and Appeal Rights were discussed and provided to House Manager/Licensee Ahmed Qasim.the state’s words, verbatim · CDSS document, Mar 25, 2024

Type of visit: Required - 1 Year

On 03/21/2024 at 09:30 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown met with a staff and was granted entry to the facility. At the time of the visit there was one (1) staff present, and six (6) residents present. House Manager Ahmed Qasim and Administrator Amirra Younes were contacted and informed of the visit. Facility Manager Amirr Younes arrived during the visit. LPA Brown explained the purpose of the visit to Facility Manager Amirr Younes. The facility is a nine (9) bedroom, three (3) bathroom home with a kitchen/dining area, living room, activity room and laundry area. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) can be non-ambulatory residents. The facility has two (2) Hospice Waiver. The current census is six (6) residents. LPA Brown was accompanied by Staff #5 (S5) 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). LPA Brown observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 71 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, and storage space, lamps and chair. Moreover, LPA Brown observed that bathrooms were clean, and appliances were operating appropriately. LPA Brown observed grab bars and non-skid mat in the resident bathrooms. LPA Brown measured and observed the water temperatures in the bathroom to be at 169.4 degrees F. Deficiency will be issued. House Manager regulated the hot water temperature to 106 degrees Fahrenheit during the visit. LPA Brown observed no night lights maintained in hallways and passages to nonprivate bathrooms at the facility. Deficiency will be issued. House Manager Younes purchased night lights during the visit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCLD complaint poster, Ombudsman poster and the disaster plan were posted in a common area. Moreover, during the tour of the facility, LPA Brown observed knives drawer not locked in the kitchen, accessible to residents in care. ***Continuation in LIC809C *** In addition, LPA Brown observed cleaning solutions, bleach in the laundry area and readily accessible to residents in care. Also, LPA Brown observed cleaning solutions, bug killers stored under the bathroom sink, readily available to residents in care. Knives cabinet were also observed not locked and knives accessible to residents in care. Deficiency will be issued. House Manager Younes locked the chemicals, cleaning solutions, toxics and knives during the visit. There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the medication room. LPA Brown found medications pre-poured for the week for Resident #1 (R1). LPA Brown explained that no medications shall be transferred between containers. Deficiency will be issued. Food Service: Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator and house managers. LPA Brown observed sufficient number of staff to provide care and supervision to the residents in care. LPA reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA Brown observed Resident #2 (R2) does not have Pre-Admission Appraisal. Deficiency will be issued. Also, LPA Brown observed no updated Physician Report (LIC602) for Resident #3 (R3), last LIC602 Physician signature date's 01/07/2006. Deficiency will be issued. LPA Brown observed no staff files available to review for Staff #5 (S5), Staff #6 (S6) and Staff #7) for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test result. Deficiencies will be issued. Furthermore, LPA Brown obtained information that two (2) adult individuals were living at the ground floor of the two (2) storey house at the back of the facility. Per documents review, the two (2) individuals reported don't have criminal background clearance and have been living at the facility since 01/05/2024. Deficiency will be issued and civil penalty of $500.00 per individual will be assessed during today's visit and will continue to be assessed of $100.00 per day, per individual until corrected. Medication Audit were completed for three (3) residents. LPA Brown observed that Staff #5 (S5) dispensing Resident #1, Resident #2 and Resident #3 medications and not updating R1, R2 and R3 Medication Administration Record (MAR) per physician's directions. Deficiency will be issued. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D, LIC421BG and Appeal Rights were discussed and provided to House Manager Amirr Younes.the state’s words, verbatim · CDSS document, Mar 21, 2024

Allegation investigated: Adult residing in the facility is using illegal drugs inside of the facility. Staff did not assist resident with administering medications as prescribed. Staff did not assist resident with obtaining medical care. Staff did not provide resident with a copy of an admissions agreement.

On 10/27/2023 at 12:00 PM, Licensing Program Analyst (LPA), Melody Brown, met with Licensee/Administrator Ahmed Qasim at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office to deliver the findings of the above allegations. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews, and a review of pertinent documentation. The Department conducted investigation into allegation of Staff # 6 (S6) used illegal drugs inside the facility. Former Resident #1 (R1) reported allegedly witnessing S6 smoking crack and meth inside the facility. The investigation consisted of interviews with residents and staff members. Residents and staff interviews indicated they did not witness S6 using illegal drugs inside the facility. Therefore, based on the evidence obtained during the Department’s investigation, the allegation of Staff #6 used illegal drugs inside the facility is unsubstantiated at this time. *** Continuation in LIC9099C *** Unsubstantiated The second allegation alleges that Staff did not assist resident with administering medications as prescribed. LPA Brown did not find evidence to corroborate the allegation. S1 reported to LPA Brown that R1 was never a resident at their facility but resided at the back building with a different Operator. Interviews with Resident #2 (R2), Resident #5 (R5), Resident #7 (R7) and Resident #8 (R8) indicated that they do not know R1 and they all cannot remember who R1 was. R2, Resident #3 (R3), R5, R6, R7 and R8 reported to LPA Brown that they do not have information regarding staff not assisting R1 with medication administration and R2, R3, R4, R5, R6 and R7 all confirmed that staffs at the facility are giving their medication on time and there's no incident that staffs failed to give them their medication. S3 informed LPA Brown that S3 never met R1 and S3 does not have information on R1's medication administration. The third allegation indicates Staff did not assist resident with obtaining medical care. LPA Brown interviewed R2, R3, R5, R7 and R8 and they all indicated that staffs’ at the facility are assisting them on obtaining medical care. S1 and S3 reported to LPA Brown that they are always assisting their residents on obtaining medical care and no incident happened at the facility that they did not assist their residents on obtaining medical care. S1 and S3 added that R1 was never their resident at the facility. Interview with S1 revealed that R1 resides at the back building of the facility operated and managed by a different owner therefore they do not have available information regarding staff not assisting R1 with obtaining medical care.. The fourth allegation indicates Staff did not provide resident with a copy of an admissions agreement. LPA Brown did not find evidence to corroborate the allegation. Interviews with R2, R3, R5, R7 and R8 indicated that staffs’ at the facility provided them with a copy of their admissions agreement. S1 and S3 reported to LPA Brown that the facility's providing a copy of admission agreement to their residents and they both indicated that there's no incident happened at the facility that their residents were not provided a copy of their admission agreement. To add to that, S1 reported to LPA Brown that R1 was a never a resident at their facility that's why there's no Admission Agreement document for R1. S1 indicated that R1 was a resident at the back building of the facility operated and managed by a different owner. Based on the evidence, the allegations Adult residing in the facility is using illegal drugs inside of the facility (Allegation #1), Staff did not assist resident with administering medications as prescribed (Allegation #2), Staff did not assist resident with obtaining medical care (Allegation #3), Staff did not provide resident with a copy of an admissions agreement (Allegation #4) are UNSUBSTANTIATED. ***Continuation in LIC9099C *** A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 was discussed and provided to Licensee/Administrator Ahmed Qasim.the state’s words, verbatim · CDSS document, Oct 27, 2023 · control 56-AS-20230308123000