198320685-7-28-2026-11-AS-BALN-DWEPZ4-20260728114456

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320685
Report Date: 07/28/2026
Date Signed: 07/28/2026 11:45:06 AM

Document Has Been Signed on 07/28/2026 11:45 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME:	AURORA VISTA ASSISTED LIVING		FACILITY NUMBER:	198320685
ADMINISTRATOR/ DIRECTOR:	MUHAMMAD, NAIMA		FACILITY TYPE:	740
ADDRESS:	27767 HAWTHORNE BLVD		TELEPHONE:	(310) 621-4591
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY: 6		CENSUS: 0	DATE:	07/28/2026
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:20 AM
MET WITH:	Naima Muhammad -Administrator		TIME VISIT/ INSPECTION COMPLETED:	12:00 PM

NARRATIVE

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On 7/28/2026, Licensing Program Analyst (LPA), Bernadette Allen conducted an announced visit to conduct a pre-licensing inspection. Upon arrival LPA met with Nasir and Naima Muhammad the licensee/administrator.

An application for fire safety inspection was submitted to Community Care Licensing Division (CCLD) on 2/24/2026. The fire clearance was inspected and approved on 3/4/2026 for age range: 60 and over. Approved for 2 ambulatory, 4 non-ambulatory, of which 1 may be bedridden. 2 ambulatory in bedroom #1, 1 bedridden in bedroom #2, 2 non-ambulatory in bedroom #3, and 1 non-ambulatory in bedroom #4. Hospice waiver granted for (2).

Physical Plant/Structure:

At 9:50 AM, The department toured the physical plant and the following was observed.

four (4) bedrooms, three (3) bathrooms, living room, dining room, kitchen, laundry area and storage room/garage which will not be utilized for care and a backyard with shaded area.

The department did not observe any bodies of water and property was free of debris/obstructions.

Bathroom Structure:
The three (3) bathrooms were observed to have a working toilet, wash basin, and shower equipped with rails and a slip resistant mat. The bathrooms can accommodate non-ambulatory residents.

Water temperatures measured in each bathroom ranged between 105°F and 120°F.

Stephanie Cifuentes
Bernadette Allen
	DATE: 07/28/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: AURORA VISTA ASSISTED LIVING	FACILITY NUMBER: 198320685
	VISIT DATE: 07/28/2026

NARRATIVE

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Bedrooms: The four (4) bedrooms were observed to have the following, beds which appeared to be in good condition with the required linens, appropriate lighting and lamps, nightstands, dressers, closet/storage.

Medications, First Aid Kit & First Aid Book:
The Department observed a new first aid kit containing a thermometer, tweezers, scissors, antiseptic, bandages, gauze, and a current first aid manual.

Linens & Hygiene Supplies:
The Department observed additional linens and hygiene supplies stored and available for resident use.

Food Service:
The Department observed the facility kitchen to contain a five-day supply of perishable food items and a seven- day supply of non-perishable food items, all stored and maintained properly. Dishes, cups, and flatware were stored in the kitchen and appeared to be in good repair.

Smoke Detectors:
The Department observed the facility to have operational smoke detectors and carbon monoxide detectors. All devices were tested and found to be working, and fire extinguishers were fully charged.

Toxins:
The Department observed toxins, cleaning supplies, and knives stored locked, making them inaccessible to residents.

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Bernadette Allen
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/28/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: AURORA VISTA ASSISTED LIVING	FACILITY NUMBER: 198320685
	VISIT DATE: 07/28/2026

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Appliances:
The facility has a working refrigerator, stove, oven, microwave, washer, and dryer. knives/sharps were also locked inaccessible to residents. The residence is equipped with central air and heating.

Residents & Staff Files:
At the time of the pre-licensing inspection, there were no resident files available for review. There is also a place for staff and residents’ files as well as medications locked in the hall cabinet.

Smoke and carbon monoxide detectors were operational and tested during the visit. The water temperature ranged from 105°F to 120 °F, the department also observed cleaning supplies / toxins stored in the laundry area inaccessible to residents.

All fire extinguishers were charged and operable. The first aid kit with required essentials and book were observed.

Component III:
During the pre-licensing visit, between 8:20 AM and 11:30 AM, Component III orientation was provided to the licensee. Information was reviewed regarding how to operate the facility in substantial compliance with applicable regulations and is ready to be licensed.

Based on the Department’s inspection of the facility,

An exit interview was conducted with, Nasir and Naima Muhammad and a copy of the report was provided at the conclusion of the visit.

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Bernadette Allen
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/28/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026

LIC809 (FAS) - (06/04)

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