Gentle Serenity

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Khojesta Azizi and explained the reason for the visit. The Administrator's certificate expires on July 17, 2028. The facility is licensed for 6 non-ambulatory residents of which 1 can be bedridden (bedroom #1 only) and a hospice waiver for 6. Facility has 7 bedrooms, 1 is for staff, 3 bathrooms, kitchen, great room and an attached 2 car garage. LPA and the Administrator toured the facility. LPA observed the resident rooms had all the required furnishings and bed linens. LPA observed all 3 bathrooms are clean operational. Hot water measured 119.0 degrees Fahrenheit in bathroom #1. LPA observed extra linens and towels stored in the hall pantry. Smoke detectors/carbon monoxide detectors tested operational. The last emergency drill was conducted on July 10, 2026. LPA observed the fire extinguisher in the kitchen and the fire extinguisher in the great room are both fully charged. LPA observed the knives and sharp objects are kept locked in a kitchen drawer. LPA observed a two day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the 5 burner gas stove had safety covers on the knobs. LPA observed the 5 burner gas stove can be lighted unassisted. LPA observed the medication is kept locked in a cabinet in the kitchen. LPA observed the garage is kept locked and used for storage of old furniture and supplies. LPA and the Administrator toured the backyard. There is a shaded area to sit outside. LPA observed a raised fountain in the backyard. The fountain is empty and has no water. LPA observed the exit gate on the east side of the facility is operational. No obstacles or hazards observed in the backyard. LPA reviewed LPA reviewed 2 staff records. LPA observed Staff 1 did not have a health screening but did have a negative TB test on file. Both staff members have the required training and CPR/First Aid training. No other discrepancies observed. Both staff members are background cleared and associated to the facility. LPA reviewed 6 resident records and medications. No discrepancies observed. LPA inspected the first aid kit. The first aid kit has all the required elements. LPA observed the facility did not have a dedicated internet device for resident use. Deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.the state’s words, verbatim · CDSS document, Aug 19, 2026

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: Prelicensing

Licensing Program Analysts (LPAs) Celine Rodriguez and Garlli Tat conducted an announced visit for the purpose of conducting the Pre-Licensing visit for a Change of Ownership (CHOW). LPAs conducted the visit with Applicant/Administrator (AD) Khojesta Azizi. The initial application to operate a Residential Care Facility for the Elderly (RCFE) was received by the Department of Social Services on July 29, 2025 for age range 60 and over, of which 6 may be on hospice, 5 may be non-ambulatory, and 1 bedridden. For this visit, there are a total of 6 residents in care. Structure: Facility is a single level structure. On 3/18/2025, The Orange County Fire Authority granted a fire clearance for a capacity of 6 residents (which 5 may be non-ambulatory, and 1 may be bedridden). There are a total of 7 bedrooms, which 6 are private resident rooms and 1 room designated for staff. Bedrooms: All bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept hazard free. Bathrooms: There are a total of 3 restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature was measured to be at 118.4 degrees Fahrenheit. Linens and Hygiene Supplies: Adequate supply of linens is stored in the hallway cabinet. Posters, Emergency Phone Numbers, Exit Plan: LPAs observed the PUB475 "See Something, Say Something" poster, emergency disaster plan, and administrator certificate for Khojesta Azizi which expires on July 17, 2026. These were posted at the main entrance. Continued on LIC809-C... Food Service and Menu: Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to the residents in care. Facility had back-up emergency food and water supply located in the pantry. Smoke and Carbon Monoxide Detectors: Smoke and carbon monoxide detectors were tested and operational. Alarms: There are auditory alarms located on all exit doors of which all were tested and operational. Fire Extinguisher: Fully charged, mounted, and located in the kitchen and tagged for 2025. Appliances: Stove is a four-burner induction stove, and there is single oven, dishwasher, refrigerator and freezer. Washer and dryer are located inside the garage. Toxins: Locked and inaccessible to residents. Medications, PPE First-Aid Kit and Manual: LPAs observed that First Aid Kit had all the required components. Medications were locked in a cabinet located in the kitchen. Backyard: No bodies of water were observed. There are 2 exit gates in the backyard, of which both are self-closing and self-latching. Resident and Staff Files: Records were kept in a locked cabinet located in the kitchen. Recreational Activities: The facility has activities that commensurate with plan of operation. LPA Rodriguez reviewed the Component III with AD Azizi. Per interviews, Licensee/Administrator stated that they are not planning to advertise for special dementia program for this facility as of this time. Pre-licensing visit and Component III are now complete. LPAs will provide copy of this report to Centralized Applications Bureau for review and final determination of the application. LPAs advised AD Azizi to utilize the main office email: CCLASCPOrangeCountyRO@dss.ca.gov for additional inquiries. LPAs conducted an exit interview with AD Azizi, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Aug 5, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Khojesta Azizi CEO/Administrator Interview Method: Telephone interview On July 22, 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 that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-Licensing Readinessthe state’s words, verbatim · CDSS document, Jul 22, 2025