Primrose

Type of visit: Required - 1 Year

On 1/26/2026 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct the required Annual Inspection. Upon arrival, LPA was greeted by the Caregiver Mylene Banda, who granted access to the facility. LPA explained the reason for the visit. LPA Khurshudyan reviewed the required postings posted on the entrance wall and throughout the facility. The Administrator Nino Smith arrived shortly after. At approximately 11:30am LPA requested staff and residents’ rosters for review. The inspection tool was used to complete the visit. At 11:50am LPA, with the help of the Caregiver, began a physical plant tour of the facility and the following was observed: This is a single-story building with six (6) bedrooms of which five (5) rooms are designated for residents’ use, and one (1) for staff use only. There are three (3) bathrooms, a kitchen, common areas: living and dining rooms, and an outdoor area. Facility has an approved fire clearance for six (6) Non-ambulatory residents, all of which may be bedridden, and a Hospice waiver for six (6) residents. Kitchen: LPA observed a seven-day supply of non-perishable food, and a two-day supply of perishable food properly stored and labeled. No expired food was observed. Facility stores knives and sharps inside the locked cabinet. Sufficient amount of emergency supply of food / water was readily available. Food storage and preparation areas are clean and inaccessible to pests. LPA observed one (1) fire extinguisher located on the kitchen wall. The fire extinguisher was last serviced on 9/9/2025. Dish soap and other chemicals were observed to be stored under the kitchen sink, inside the locked cabinet and inaccessible to residents in care. Continue on LIC809-C Bedrooms: LPA observed bedrooms to be properly furnished with beds, linens, night stands, chairs, drawers, closets, and adequate lighting. All bedrooms appeared organized and clean. Residents have enough personal hygiene products. Common Areas: These include a den, living and dining areas. LPA observed dining, living areas clean and clear of clutter. Furniture is generally new and in a good repair. Dining and living room furniture sits at the capacity of the facility. Walls, floors, windows, screens, and blinds were clean and in good repair. At 12:10pm, LPA measured the room temperature to be 73 degrees Fahrenheit. There is a linen closet with an adequate supply of fresh linens ready to use. No obstructions and or tripping hazards found inside the facility. Facility has landline, LPA checked it was operational. Bathroom: The bathrooms contained hand soap, paper towels, toilet paper and trash bins with lids. The hot water temperature was measured at approximately 12:25pm to be 114.3 degrees Fahrenheit. The bathrooms were checked for cleanliness and proper operations. Towels and washcloths are not shared. LPA observed non-skid mats and grab bars inside the bathrooms. Smoke and Carbon Monoxide Detectors: The smoke and carbon monoxide detectors were tested by staff at approximately 2:20pm and were observed to be operational. Garage: There is a garage in the premises and is currently being used for storage. Laundry Room: Functioning washer and dryer is located in the separate area adjacent to kitchen. Laundry detergents and other chemical supplies observed locked inside the kitchen cabinet. Backyard/Front yard: LPA observed sufficient yard space and fenced backyard with appropriately covered shaded area available for residents to rest. There is outdoor furniture under the shaded area. LPA discussed the importance of maintaining care and supervision to meet the needs of clients. During the physical walk through LPA observed all exit areas to be free of clutter and obstruction. There is no body of water. Staff/Client File review: Facility records are also kept inside the locked kitchen cabinet. Between 12:40pm -2:00pm LPA conducted records review of four (4) staff files and six (6) residents’ records. Files were complete and updated. Continue On LIC809C Medications: At approximately 2:05pm, LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. The facility also maintains Medical Administration Records (MAR). LPA observed centrally stored medications locked inside the kitchen cabinet and inaccessible to residents in care. Complete First-aid kit is also available and placed in the common area. No potentially dangerous items were found in the facility. The facility operates with two (2) shifts and has two (2) staff members for each shift. LPA conducted interviews with the Administrator, two caregivers and four (4) residents who was able to communicate and answer questions. Facility plan/sketch is posted on the wall along with other posting requirements. LPA collected LIC500, LIC9020, and copy of Liability Insurance, and copy of Administrator certificate at the time of the visit. The Administrator certificate will be expiring on 12/5/2026. The facility has balance of $742.00 of licensing fees which will be paid on 1/26/2026. No Deficiency issued during today’s visit. Exit interview conducted, a copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jan 26, 2026

Type of visit: Case Management - Other

On 5/7/2025 at 12:30pm, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an unannounced Case Management-Other visit to the above facility. Upon arrival LPA met with the Caregiver Mylene Banda, introduced herself by showing her department badge and explained the reason for the visit. LPA was informed that Resident #1 (R1) who has been relocated from Santa Clarita Hills Senior living is currently residing in the above facility. At 12:40pm LPA requested LIC9020 and reviewed which confirmed that R1 is residing the above-mentioned facility since 3/8/2025. No deficiencies issued during today’s visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, May 7, 2025

Type of visit: Required - 1 Year

On 1/10/25 an unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena Khurshudyan. Upon arrival, LPA met with the Caregiver Janet Araba, who granted access to the facility. LPA introduced herself and explained the reason for the visit. Shortly after the Administrator, Mubeen Naimuddin arrived and helped with physical plant tour and staff/residents files. During today's visit, LPA conducted a physical plant walk through, at approximately 11:00am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22. The following was observed: The facility is a single-story home and is licensed for capacity of six (6) residents, of which six (6) may be Non-Ambulatory and of which fire clearance for six (6) Bedridden. Facility also has a hospice waiver for six (6) residents. There are six (6) bedrooms in the facility of which five (5) are designated for residents’ use. All bedrooms observed to be appropriately furnished. All bedrooms have appropriate lighting. There are three (3) bathrooms in the facility of which two (2) are designated for residents’ use and one (1) for staff use. LPA observed bathrooms have soap, paper towels and hand washing signs. The hot water temperature measured at 11:30 to be 109°F. Extra towels and linens were readily available. There are grab bars for each toilet and shower, bathrooms have non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination. LPA observed facility alarms were present on all exit doors and all of the signals were functional. SMOKE DETECTORS/CARBON MONOXIDE. The smoke detectors and carbon monoxide are hard wired, inter-connected and were located throughout the facility. At 12:00pm they were tested and observed to be operational. The facility has one (1) fire extinguisher that was last purchased on August 12, 2024. Continue on LIC809-C KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven, dish washer and sink. The kitchen appliances and fixtures were functional. LPA observed the kitchen area, there was sufficient stock of one week non-perishable foods and two days of perishable foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. LPA observed that sharp objects were stored in a locked drawer inaccessible to residents in care. Extra emergency food was properly stored inside the storage cabinet. The common areas which include dining and living room appeared clean and were properly furnished. Temperature was comfortable it was measured at 11:45am to be 72°F. No obstructions and or tripping hazards throughout the facility found. MEDICATION: LPA observed centrally stored medication and First Aid kit locked in the kitchen cabinet and inaccessible to residents in care. LPA observed First-aid kit is complete and has new manual. Facility has Dementia Care Program. PRN medications have written orders from a physician. The facility serves residents with dementia and facility has trained staff to meet the needs of residents who are diagnosed with dementia. Facility has two (2) staff for AM shift and two (2) awake caregiver for PM shift. COMMON AREAS: LPA observed living room and a dining room that appeared generally clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Facility has land line, LPA checked its operational. LAUNDRY ROOM: Laundry machines are located in the separate area next to the kitchen. LPA observed chemicals and detergents were stored on the floor, not locked and accessible to residents in care. LPA discussed the importance of keeping potentially dangerous items locked at all times. SURROUNDING GROUNDS: LPA observed sufficient yard space with fenced backyard. Appropriate outdoor furniture, with covered shaded area was available for residents to rest and enjoy outside weather. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. Exit doors were unlocked and free of obstructions. The facility does not have a swimming pool or body of water. There is a garage in the property, which is currently being used for storage. FILE REVIEW: Between 12:45pm to 2:30pm, LPA reviewed records and files of six (6) residents and six (6) staff/caregivers. A review of staff and resident records appeared to be complete. Resident’s files contain signed admission agreements and a medical assessment, and all other required documentarians. Continue on LIC809-C A review of staff records indicates that all facility staff and who required caregiver background checks have received criminal record clearances. There are no residents with prohibited conditions residing at the facility. Facility also provides activities to the residents. An emergency exit plan/sketch along with other posting requirements are posted on the wall in the living room. Medications Review: At approximately 2:45pm. LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. Facility also maintains Medical Administration Records (MAR). PRN medications have written orders from a physician. Potentially dangerous items are kept inaccessible to residents in care. Facility operates with two (2) shifts. LPA collected LIC500, LIC9020, copy of Liability Insurance Certificate, and Facility Disaster Plan. Citation issued during this visit and appeal rights were provided. See LIC809-D Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jan 10, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan, met with Administrator Mubeen Namuddin for a One (1) year required visit for this facility. A tour of the physical plant was conducted at 9:23 AM and the following was noted: There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. The facility has six (6) bedrooms and three (3) bathrooms currently occupying five (5) residents. One (1) bedroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory resident, all of which maybe bedridden. Hospice waiver for six (6) residents. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 74°F. Dual smoke and carbon monoxide detectors were tested and observed to be operational. There is a fire extinguisher located in the kitchen and was observed to be full and last inspected on 09/20/23. The facility is equipped with fire sprinkler system. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. (continued on LIC 9099-C) (continued from LIC 809) There is no garage at the facility. The garage was converted into a storage and staff quarter. It is also being used as storage for frozen foods, PPE and other toxins. Laundry room is located adjacent to the kitchen and was observed to be locked. All the laundry detergents, cleaning solutions, toxins and other chemicals are observed to be locked in a cabinet in the laundry room and locked cabinet under the sink. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days of non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. All sharps and knives were also observed to be locked in the kitchen cabinet. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. Sink in the bathrooms were removed and under construction. The hot water temperature measured at a range of 113.9°F to 115.1°F Towels and washcloths are not shared. There is enough clean linen available in stock at the cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. There is a complete first aid kit located in the medication cabinet. Client records: Client records are reviewed. Residents records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appear to be complete and updated. Disaster drill was last conducted on 02/21/24. Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Mar 2, 2024