Elite Senior Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Vaid conducted an unannounced annual licensing inspection. LPA Vaid explained the purpose of the visit to Administrator Gladys Pervez, this facility is a Residential Care for Elderly (RCFE) to serve residents for age 60 and above. The capacity is six (6). Facility has a Dementia Care program for six (6) residents. Hospice waiver was approved for five (5). Administrator Gladys Pervez has an RCFE Certificate expiring on 02/08/2027. During the visit, CARE tool was used, a tour of the facility was conducted, food supply was reviewed, staff were interviewed, files were reviewed, and medications were reviewed. The facility is a single-family house located in a residential neighborhood, consisting of a living room, laundry room, dining room, kitchen, five (5) resident rooms, two (3) bathrooms, front yard and backyard is furnished with shaded areas. Residents' rooms are furnished with appropriate furniture for residents’ comfort. The bathrooms are furnished with grab bars and nonskid surfaces. Adequate linen and personal hygiene supplies are observed. Common areas are observed for the ability to safely serve the needs of the residents. Smoke detectors and carbon monoxide detectors are hardwired and operational. Fire extinguishers are fully charged. Facility maintains a comfortable temperature for residents. Auditory alarm devices to monitor exits are operable. Sufficient supply of perishable and nonperishable foods is observed. Hot water temperature is measured at 109.8, 106.9 and 112.2 respectively, degrees Fahrenheit which is within Title 22 Regulation guidelines. Fire drill was conducted on 04/15/2026. Medication is centrally stored in a locked storage room and inaccessible to residents. Facility has first aid kit with manual. Resident records are stored in a locked storage room and inaccessible to residents. Liability insurance expires 12/16/2026. No deficiencies were observed per California Code of Regulations, Title 22. An exit interview was conducted. This report was discussed with Administrator, Gladys Pervez, whose signature on this LIC 809 form confirms receipt of these documents provided.the state’s words, verbatim · CDSS document, May 14, 2026

Type of visit: Case Management - Licensee Initiated

Licensing Program Analyst (LPA) Sanjay Vaid conducted an announced visit to the facility. The facility serves six (6) non-ambulatory elderly residents of which one (1) may be bedridden, ages 60 and above. Facility is approved for five (5) hospice residents. LPA Vaid met with Licensee Gladys Pervez whom assisted with the final inspection of two new rooms addition to the facility. All documents were provided by the Licensee and approved by the Department. The Licensee has added two bedrooms and one bathroom to the existing facility floor plan. The two (2) new rooms have the required furnishings: bed with linens, night table and lamp, chair, sufficient closet space, egress alarms on the sliding door, alarms are operational. Bathroom: Observed with non skid mats, grab bar, toilet and shower are operational, water temperature measured at 106.3 deg F. Pathways are free of debris and obstruction, toxins and sharps are inaccessible to clients in care. LPA and Licensee toured the facility and did not observe any health and safety concerns. Exit interview was conducted and copy of this report was provided to the Licensee, Gladys Pervez.the state’s words, verbatim · CDSS document, Mar 5, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met Caregiver Linda Holgado at approximately 12:30 PM and explained reason for visit. Administrator Gladys Pervez arrived shortly. This facility is a Residential Care for Elderly (RCFE) to serve residents for age 60 and above. The capacity is six (6) non-ambulatory residents. Facility has a Dementia Care program. Hospice waiver was approved for six (6). The facility is a single-family house located in a residential neighborhood; consisted of a living room, laundry room, dining room, kitchen, three (3) resident rooms, two (2) bathrooms, front yard, backyard and garage. Faculty is under construction with approved building permits no fire clearance for new construction. All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, and lighting. Smoke detectors/carbon monoxide detectors were observed in each room and throughout facility. The facility has one (1) fire extinguisher that is fully charged in kitchen. Cleaning supplies and toxic substances are inaccessible locked in laundry filing cabinet. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. There are no firearms or weapons stored at the facility The resident bathrooms have the required grabs bars and non-skid mats. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The common areas include the living room and dining area are clean and have the required furniture. The facility does not have a swimming pool or large body of water. There is a shaded seating area for the residents in back yard. Passageways and exits are free of obstruction. LPA observed paint supplies and tools in shaded seating area in backyard. Three (3) staff files were reviewed and included Criminal clearance record, and health screening with TB, and CPR/First Aid certificates. Two (2) resident files were reviewed and included physicians report, TB clearance, and appraisal needs and service plans. Last fire/earthquake drill was conducted in January of 2025. Infectious control plan was reviewed. Two (2) staff and one (1) resident were interviewed. Resident medications were reviewed, and no discrepancies found. Medications are centrally stored and locked MAR log is used. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809Ds. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, May 1, 2025

The state marks this report as 5 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 Analysts (LPAs) Reyes and Tao conducted an unannounced annual licensing inspection. LPA Reyes explained the purpose of the visit to Administrator Gladys Pervez, This facility is a Residential Care for Elderly (RCFE) to serve residents for age 60 and above. The capacity is six (6). The licensee is Elite Manor Inc. Facility has a Dementia Care program for six (6) residents. Hospice waiver was approved for five (6). Administrator Gladys Pervez has an RCFE Certificate issued for 02/09/2023 with an expiration date of 02/08/2025. During the visit, CARE tool was used, a tour of the facility was conducted, food supply was reviewed, staff/residents were interviewed, files were reviewed, and medications were reviewed. The facility is a single family house located in a residential neighborhood; consisted of a living room, laundry room, dining room, kitchen, five (3) resident rooms, two (2) bathrooms, front yard and backyard. Residents' rooms are furnished with appropriate furniture for residents’ comfort. The bathrooms are furnished with grab bars and nonskid surfaces. Adequate linen and personal hygiene supplies are observed. Common areas are observed for the ability to safely serve the needs of the residents. Smoke detectors and carbon monoxide detector are tested and operational. Fire extinguishers are fully charged. Facility maintains a comfortable temperature for residents. Auditory alarm devices to monitor exits are operable. Sufficient supply of perishable and nonperishable foods is observed. Hot water temperature is measured at 113.5 degrees Fahrenheit which is within Title 22 Regulation guidelines. Fire drill was conducted on 04/06/24. Medication are centrally stored in a locked storage room and inaccessible to residents. Resident records are stored in a locked storage room and inaccessible to residents. No deficiencies were observed per California Code of Regulations, Title 22. An exit interview was conducted. This report was discussed with Administrator, Gladys Pervez, who’s signature on this form confirm receipt of these documents. A copy of LIC 809 report was provided.the state’s words, verbatim · CDSS document, May 10, 2024