Mini Manor Home

Type of visit: Required - 1 Year

On 02/11/26, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced annual inspection visit to this facility. LPA met with staff, Alfian Fnu, and explained the purpose of the visit. LPA was granted entry to the facility. Officer manager, Naomi Leibov later joined LPA Gonzalez for the inspection visit. The facility is licensed to serve six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility has an approved hospice waiver for three (3). Currently there are five (5) residents in care. The facility is a single-story structure located in a residential neighborhood and consists of the following: three (3) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, living room, kitchen, dining room, laundry room and an outdoor shaded area in the front of the home. LPA Gonzalez toured the physical plant inside and out. There were no bodies of water or obstructions on the premises. All rooms were inspected; bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Bathrooms were operational and observed to be within Title 22 regulations. The facility was observed to be appropriately furnished at the time of visit. A comfortable temperature was maintained in the facility. The kitchen was inspected and observed to be within Title 22 regulations. Sufficient perishable and non-perishable food supply was maintained adequately. All sharps, toxins, cleaning solutions, and hazardous items, were securely locked and inaccessible to residents. A review of Medication Administration Records was maintained in order and accurate. Continued on LIC9099-C The facility has a landline telephone on-site in working condition. Smoke detectors and carbon monoxide detectors were operational and working properly. Fire extinguishers were fully charged. A stocked First Aid kit along with manual was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents. There are sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved CCLD Mitigation Plan. The facility’s last fire drill was conducted on 01/26/26. the facility’s annual fees are current. No deficiencies were cited during this visit. An exit interview was conducted, and a copy of Report and Appeal Rights was provided..the state’s words, verbatim · CDSS document, Feb 11, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Eilat Nahum , Administrator and the purpose of the visit was discussed. The facility is licensed to serve 6 non- ambulatory residents age 60 and over of which 1 may be bedridden. The facility has an approved hospice waiver for 3 residents. None of the residents are diagnosed with dementia . One (1) resident is receiving home health. No residents are currently receiving hospice care services. The facility does not handle any of the residents’ money. This home is a single story home consisting of: (3) resident bedrooms, (1) staff bedroom (2) Full bathroom, , living room, kitchen ,dining room, laundry room and an outdoor shaded patio area in the front of the home. LPA toured the Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 115.1F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. During todays visit LPA did not observe any deficiencies. Exit interview conducted with Eilat Nahum, Administrator.the state’s words, verbatim · CDSS document, Jan 15, 2025

Type of visit: Required - 1 Year

On 01/29/2024 at 8:15 AM , Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – Annual Inspection and met with Staff Djie Lan Nio. Administrator Eilat Nahum and House Manager Noame Leibov joined us 10 minutes later. Six (6) residents and three (3) staff were present during this inspection. Facility is licensed to serve six (6) non-ambulatory residents over 60. In which one (1) may be bedridden. It is approved for a hospice waiver for three (3). The facility is part of a two story apartment located in a residential area and contains the following: living room, dining room, kitchen with refrigerator, electric oven, dishwasher, sink/faucet, locked storage cabinet for medications, (3) resident rooms, (1) bathroom; bathroom with shower, toilet and washbasin, room #1 contains a private closet, washer and dryer. A front yard and a backyard with shaded/furnished area for resident use. The residence is equipped with central air and heating. Staff and Administrator accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured between 119F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Continue to LIC 809-C. Common areas were clean and clear of hazards, doorways were free of obstructions. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher was observed in the living room. Administrator tested all carbon monoxide detectors and smoke detector located near residents’ room. Both devices were functional. 5 staff records were reviewed. Two staff interviews were conducted. 5 resident records were reviewed and, 5 out of 5 client records had Medical Assessments. Two residents’ medication was reviewed. Two residents were interviewed. Deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. During record review, on two occasions, LPA observed vermin on the dining table and in the resident's file. LPA also observed dead vermin near the baseboard in the dining room. LPA and Administrator observed vermin on dining ceiling. The Administrator immediately spoke with the landlord to establish pest control services. During record review, LPA did not see an eligible Guardian clearance for staff #3 hired 12/04/2023. S3 is only cleared at the licensee's other facility. S3 was not on-site. At 12:54 PM, the House Manager notified LPA that the deficiency was corrected. LPA verified that the deficiency had been resolved. An exit interview was conducted, technical assistance provided, Plans of Corrections were developed and reviewed. A copy of this report and appeal rights were discussed with the House Manager and left with Staff Djie Lan Nio.the state’s words, verbatim · CDSS document, Jan 29, 2024