Huntington Beach Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPA was greeted and granted entry by care provider Diana Gunita after explaining the purpose of the visit. Administrator (AD) Ali Naghibi was notified via telephone and later arrived to assist with the inspection. LPA observed the Administrator certificate was current with an expiration date of June 9, 2028. This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents, of which one may be bedridden, with a hospice waiver for six. The facility is a one-story home with six resident bedrooms, one staff bedroom, seven bathrooms, living room, dining room and an attached two car garage. During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: LPA observed residents watching television in their respective bedrooms. LPA observed five residents in care and three staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the wall in the living room. LPAs observed that all resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored in the hallway storage closet. LPA observed bathrooms were clean and equipped with grab bars, toilet paper, paper towels, and non skid floor mats. Bathrooms faucets and toilets were operational. Water temperature tested between 108.1 and 111.2 degrees Fahrenheit. LPA observed all windows were appropriately screened. LPA toured the outside of the facility and observed outdoor passageways were free of obstruction. LPA observed the backyard had a shaded sitting area with furniture for resident use. Continued on LIC 809-C LPA observed the facility had a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Gas stove and microwave were inspected and observed to be operable. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with a service date of June 25, 2025 and located by the facility entrance and in the hallway. Toxic chemicals, cleaning solutions, and disinfectants were observed to be locked and inaccessible to residents under the kitchen sink and in the garage. Medication cabinet was observed to be locked and centrally stored in a living room closet. LPA observed the First Aid Kit had all the required components. LPA observed the facility conducted their last emergency disaster drill on March 31, 2026. While waiting for the AD, LPA began review of the electronic records. LPA Guillen reviewed five resident records. All the required documentation were present and current in the resident files reviewed. LPA reviewed three employee records. All employees present have a criminal record clearance and were associated to the facility. LPA observed records reviewed have a current First Aid certificate. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and the Legionnaire’s Disease fact sheet was left at the facility.the state’s words, verbatim · CDSS document, Apr 14, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) William Vanegas made an unannounced inspection for the purposes of conducting an annual inspection, upon arrival LPA Vanegas was greeted and granted entry to the facility by Care Giver (CG) Corsini Reyes, and explained the purpose of the inspection. LPA Vanegas set up equipment and began a tour of the facility and observed the following. This is a one storied home with seven bedrooms six of which are for residents and one of which is for staff. There are seven bathrooms six of which are private bathrooms, and one of which is a shared staff and visitor bathroom. The home also has an attached two car garage. LPA Vanegas observed kitchen area to be clean and free of any debris and mildew. LPA Vanegas observed a two day supply of perishable food and a seven day supply of non-perishable food. LPA Vanegas observed a sufficient amount of emergency water as well; for staff and residents in care. LPA Vanegas observed a microwave, refrigerator, gas stove, dishwasher, washer, and dryer all in good repair, and operational. LPA Vanegas observed all fire extinguishers to be up to date, and fully charged. LPA Vanegas observed all smoke and carbon monoxide detectors to be in good repair and operational. LPA Vanegas observed outside of the facility to have a large backyard with a shaded sitting area, and for the backyard to be large enough to participate in outdoor activities upon resident request. LPA Vanegas observed no obstructions along emergency exit routes, and side doors are self latching and unlocked. CONTINUED ON LIC809C. LPA Vanegas reviewed 3 staff files, and 5 resident files. All files (Staff & Resident) contained all required documents, and all staff annual training is completed and up to date. LPA Vanegas observed all resident rooms to have the required furnishings such as a bed, lamp, chair, chest drawers, enough storage space for personal items, and clean linens in good repair; meaning no strains or tears. LPA Vanegas observed all resident restrooms to have the required furnishings such as grab bars, slip resistant matts, and shower chair available. Water faucets and toilets tested operational, and water temperature tested from 106.3 to 109.1 degrees. LPA Vanegas reviewed all medications to be documented correctly, and per LPA Vanegas review all medications are being administered per physicians orders. LPA Vanegas observed all medications, toxins, and sharps to be locked away, and inaccessible to residents in care. LPA Vanegas reviewed first aid kit to have all required items such as adhesive tape, scissors, tweezers, bandages, a thermometer, and first aid manual. Based on observations made during todays inspection no deficiencies will be issued, per tittle 22 chapter 8 division 6 of the California Code of Regulations. An exit interview was conducted with Administrator (AD) Ali Naghibi, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Apr 15, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jenifer Tirre made an announced inspection visit to follow up on corrections identified during Pre Licensing visit on 04/12/2024. LPA identified themselves and discussed the purpose of the visit with Licensee Ali Naghibi. An initial application to operate a Residential Facility Care for the Elderly was submitted to CCL on 8/1/2023. There are 6 residents in care during today's visit. LPA Tirre observed the following: At 9:30 AM, LPA toured the facility and observed the following: Facility has repaired towel rack in Resident restroom 5 Grab bar mounted inside resident restroom 5 Facility has posted the "Let Us No" poster in correct regulation size near entrance Toxins in garage are secured inside storage cabinets Spring on perimeter gate has been repaired Alarm on living room sliding door is operational Caregiver room has a secure lock Land line phone is operational All noted items from visit on 04/12/2024 have been addressed. The facility is ready to be licensed. Exit interview conducted with Licensee and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 26, 2024

Type of visit: Prelicensing

Licensing Program Analysts (LPA's) Jenifer Tirre and Edward Kim made an announced pre-licensing visit. LPA's identified themselves and discussed the purpose of the visit with Administrator Ali Naghlbli. An initial application to operate a Residential Facility Care for the Elderly was submitted to CCL on 8/1/2023. There are 6 residents in care during today's visit. LPA's observed facility is following infection control policies. LPA's Tirre and Kim along with Administrator Naghlbli toured the facility at 9:00 AM and observed the following: Structure: Facility is a single story residential home with seven bedrooms (six resident rooms, one caregiver room). Facility has attached garage. Living Room/ Dining Room: Adequate seating is available in the main living room. Bedrooms Residents: All rooms are equipped with appropriate lighting, chair, night stand, dresser and ample closet space. Bathrooms: All resident bathrooms have a working toilet/ wash basin. Facility has Seven restrooms. Six of seven restrooms have grab bars and non-skid surface in the shower. Emergency Phone Numbers and Exit Plan: Posted in facility. Food Service: Facility has ample perishable and non perishable food supplies. All equipment is tested for temperature and are within acceptable ranges. LPA observed a posted menu with multiple choices for residents. Smoke Detectors: Carbon monoxide detectors and Smoke detectors were tested operational. Fire extinguishers are fully charged, mounted and inspected October 10, 2023. Toxins: located in garage in an unsecured location. Water Temperature: Tested and recorded between 105.2 and 109.5 degrees F in tested bathrooms. Emergency Supplies: LPA’s observed ample emergency food and water stored on site in facility storage. LPA'S observed the emergency disaster plan and facility has submitted Infection control plan. Medications, First-Aid Kit & Book: LPA’s observed first aid kits and contained required elements. Medications are stored in locked medication cabinet. CONTINUED ON 809C Resident & Staff File: LPA’s reviewed staff and resident files during the visit. Reading Material, Games, and Equipment: LPA ‘s observed facility has Books, games and puzzles in multiple locations. Outside areas: LPA's observed outside shaded area for residents. Fire Clearance: Approved for 5 non-ambulatory residents and 1 bedridden resident on 2/26/24. Licensee to address the following corrections by 4/22/24: · The towel rack in Bedroom 5’s restroom needs to be repaired properly and repair holes on wall · Grab bar in Bedroom 5 restroom needs to be replaced · Let Us Know Poster is not regulation size, please have proper size poster 20x26 posted near entrance · Toxins in garage to be secured inside storage cabinet · Spring on perimeter gate needs to be repaired · Alarm on living room sliding door needs new batteries · Caregiver room needs to have lock due to dementia resident in care · Land line phone needs to be operational The facility is not ready to be licensed. Licensee to contact LPA when corrections are complete. Due to time constraints Component III was not conducted today and will be conducted on follow up visit. An exit interview was conducted with Licensee and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 12, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Ali Naghibi Interview Method: Telephone interview On March 14, 2024, 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 following areas: 1. Facility operation: License type, client/resident populations, and program 2. General provisions/pre licensing readiness 3. Staffing requirements & Trainingthe state’s words, verbatim · CDSS document, Mar 14, 2024