Treegrove Senior Residence

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Rebecca Borunda conducted an announced case management visit due to a request to change the facility capacity. LPA was greeted by, identified herself to, and discussed the purpose of the visit with Administrator Amirhossein Ansari. A Change of Ambulatory Status application was received by the Department on 1/4/2026, in which the licensee requested a change in ambulatory status from 6 ambulatory residents to 6 non-ambulatory residents, 1 of which may be bedridden in bedroom #1. The Fire Safety Inspection Request was approved by the local fire authority on 2/9/2026. During today’s visit, LPA toured the facility. No residents were admitted to the facility at the time of the visit. The facility sketch was consistent with the current layout of the facility. No immediate health and/or safety concerns were observed. The completed change of ambulatory status request will be forwarded to management for final review and approval. An exit interview was conducted with Administrator Amirhossein Ansari, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Mar 11, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Rebecca Borunda conducted an announced Pre-Licensing visit. LPA was met by Applicants Amirhossein Ansari and Raquel Martinez and was granted entry into the facility. The purpose of today's visit is to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. The fire inspection was completed on 8/13/2025 and the facility is approved for 6 ambulatory residents. During today's visit, LPA toured the facility and inspected every room. The facility was found to be clean, safe, and in good repair with no pathway obstructions. Resident bathrooms were observed to be clean and the toilets and showers were found to be in working order. The facility's water temperature in private and common bathrooms were measured within regulatory requirements. LPA observed locked storage areas where all hazardous and/or toxic chemicals were stored and secured. LPA observed locked storage for resident medications and resident and staff paperwork. A fire extinguisher was observed in the facility kitchen and found to be in compliance. A functioning carbon monoxide detector and smoke detectors were observed in the facility. No bodies of water were observed near or on the premises. LPA observed 7-day supply of non-perishable food. Required postings were observed in a common area of the facility. LPA reviewed facility’s Infection Control Plan and Emergency Disaster Plan. LPA conducted Component III with the applicants. The topics discussed were continuing operation requirements, record keeping/reporting, and physical plant compliance. Pre-licensing is complete, and this facility has no deficiencies. It is recommended that this facility be licensed pending final review and approval. An exit interview was conducted with the applicants, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Nov 13, 2025