Evergreen Chateau

Type of visit: Required - 1 Year

On 04/29/2026, Licensing Program Analyst (LPA) Janette Romero conducted an announced visit to the facility to conduct a required annual inspection. LPA met with Licensee Mahboubeh Arabshahi who was informed of the purpose of the visit. Licensee reported the facility has not accepted resident placement for approximately the past eight (8) years. However, licensee wishes to maintain the facility's license active in the event she decides to accept resident placement in the future. Licensee was advised to notify Community Care Licensing if and when she receives resident placement. The facility has a fire clearance for six (6) non-ambulatory elderly residents to reside in the facility's first floor. LPA toured the facility with licensee and observed the facility is made up of a two-story home with four (4) resident bedrooms, two (2) bathrooms, a kitchen, dining room, living room, and attached garage. The facility has operating utilities including electricity, water, and gas. Two of four resident bedrooms are adequately furnished. The required bedding and furniture for the remaining two rooms is stored in the garage and available for future resident placement. Resident bathrooms are equipped with grab bars. The facility has a working refrigerator and kitchen cabinet space to store a two-day supply of perishable foods and seven-day supply of non-perishable food items. Indoor and outdoor pathways are free of obstruction. No bodies of water were observed on the premises. Licensee tested the smoke alarms/carbon monoxide detectors and LPA heard them to be operational. LPA observed a charged fire extinguisher in the kitchen with a tag noting it was last serviced on 03/22/2024. Due to not having resident placement in years, LPA was unable to review resident records. Licensee's administrator's certificate expires on 06/09/2027. Licensee reported there have not been any changes to the individual licensee entity since the facility became licensed. The facility's licensing fees are current and do not have an ongoing balance. The facility has separate areas to secure centrally stored medications, disinfectants, sharp objects, confidential resident/staff files, and other potentially hazardous items for future residents. During today's visit, LPA did not observe evidence to suggest the home is currently occupied by residents. Long-Term Care Ombudsman's contact information, resident's personal rights, and updated emergency disaster plan are visibly posted on the hallway wall leading to the dining room. No deficiencies were cited during today's visit. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee Arabshahi.the state’s words, verbatim · CDSS document, Apr 29, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Javina George made an announced to the facility to conduct a 1 year required visit. LPA was greeted and granted entry and with Regina Abdelghani, Lead Caregiver. The home continues to not have any residents in care, and it has been this way since 2016. Per Regina the plan is to meet with the Administrator once she returns back to the Country, to see what the plan will be moving forward. LPA verified contact information for the facility and will update the facility phone number as needed. LPA conducted a tour of the interior and exterior areas of the facility. The facility was observed to be be clean, and clutter free with all exits being clear from any obstructions. The sharps, chemicals and other hazardous items were observed to be locked. There are no pools of bodies of water on the premises, as well as no known guns or ammunition. The facility was observed to have (1) smoke detector with a battery inside that was operable. LPA did not observe any carbon monoxide detectors, deficiency cited, $500 immediate civil penalties are being assessed. The facility has (2) fire extinguishers that are fully charged and last serviced on 05/10/24. The hot water temperature was tested and measured to be 113.8 degrees Fahrenheit. A facility file review was conducted on 4/2/25, and the facility annual fees were observed to not have been paid. During today's visit LPA followed up and was informed by Regina that the payment was mailed off on Tuesday 04/08/25. LPA reviewed staff files for staff present and observed for staff to possess valid CPR certification, and to have the other required training/CEUs that were completed through approved vendors. The facility was observed to be insufficient food supply, however there are no residents in care, LPA discussed the requirement of a 2 day supply of perishable and a 7 day supply of non perishable food items should be purchased prior to accepting any residents in the home. LPA observed for bedroom #2 and bedroom #3 to not have beds inside the room, however there was the other required furniture, such as lamp, and chest of drawers. Per Regina the new beds can be purchased or the resident can bring their own bed it depends on what they prefer. The facility was observed to not have the required postings: such as the PUB475, personal rights, and Long Term Care Ombudsman, facility sketch. The emergency disaster plan is reported locked inside the staff office and was unavailable for review during today's visit. LPA discussed that the facility is to submit proof of the required postings at the facility no later than 5pm Monday 04/24/25. There was no proof of valid aliability insurance, deficiency cited. Based on today's inspection a citation will be issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted where a copy of this report, 809D, LIC421IM appeal rights, LIC9098-Proof of Corrections form, glossary and LIC811-Confidential names list was reviewed and provided to Regina Abdelghani, Lead Caregiver.the state’s words, verbatim · CDSS document, Apr 10, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sara Martinez arrived announced to conduct the required annual inspection. LPA was granted entry and met with House Manager Regina Abdelghani and stated the facility does not have clients at the home. The facility has not had any residents since 2016. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following: Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were in good repair and were present. The outdoor area was observed to be free of hazards. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The smoke detector and carbon monoxide was operational, and the hot water temperature met department requirements. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. Facility contains an updated Infection Control Plan and Emergency and Disaster plan. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Laundry room contained locked cabinets to store cleaning supplies, soap, and detergents. Centrally stored medication will be locked in a cabinet located in the laundry room. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies and first aid kit with all required items. LPA reviewed staff file for one (1) staff and found staff have criminal record clearance, health screening with TB test, and updated training along with CPI and CPR/First Aid Certification. No deficiencies were cited at the time of the visit. An exit interview was conducted where a copy of this report was provided to Abdelghani.the state’s words, verbatim · CDSS document, May 6, 2024