Pre-licensing visit·March 1, 2022

On 3/1/2022, Licensing Program Analysts (LPAs) L. Ibo & K. Nguyen arrived unannounced pre-licensing for change of ownership. LPAs met with Administrator Elena Mihale.Licensee Antonia Arellano arrived around 6:45PM. LPAs explained the purpose of the visit. No residents observed during the visit. Facility has an approved fire clearance for 6 non ambulatory residents. Last fire inspection was conducted on 1/22/2022. LPAs inspected the facility including but not limited to 6 resident rooms, 1 staff room, 1 staff bathroom and 3 residents’ bathrooms, common areas, kitchen, dining, family room, living room, courtyard area and outside areas. LPAs observed the following during the inspection: Sticky floor Living is unorganized with the following items; kids’ trampoline, empty boxes, cluttered shoes Kitchen area; kitchen knives are placed on the counter; rotten fruits at the kitchen counter, unorganized and cluttered children’s toys & children’s supply, empty boxes, garbage’s, unlocked medication, flower base and old flowers with cloudy water, sink area has dirty dishes & pots and pans , dog food and dog water bowl located on the hallway Family room; cluttered children’s toys, basket full of toys that is blocking kitchen hallway, couch pillows was unorganized Bedroom #1; the only set up room for licensing inspection, with one bed, lamp shade, drawer, closet has multiple curtain rods and detached bedrail, lamps, unplugged TV, multiple comforter sets ...continued to lic809c... Bedroom #2; LPAs observed 1 hospital bed with open empty boxes all over the floor, pillows on top of open boxes , lamp shade on the floor, garbage bags under the hospital bed, mattress leaning on the side of the wall Bedroom #3; LPAs observed hospital bed, per Administrator “sometimes someone rest on this room” , multiple medication that was placed on top of the bed dresser Bedroom #4; LPAs observed 2 hospital beds, towels, tissue boxes, mop and duster and unused bedsheets on top of the bed Bathroom adjacent to family room; LPAs observed hoyer lift, sticky flooring, unlock air freshener spray Bedroom #6 was set up as a nursery room Bedroom #5 was set up as storage room Medicine cabinet is located adjacent to bedroom #5, LPAs observed that key was attached to the medicine cabinet, inside the cabinet are unorganized random first aid supplies Bathroom right next to family room, LPAs observed unlocked disinfectant and cleaning supplies, air vent was open with missing cover/lid Hallway next to bedroom #1, LPAs observed cleaning supplies, gallon of bleach and heavy-duty degreaser Garage was observed to have scattered/unorganized random cleaning supplies, hoyer lift, water dispenser and etc. Staff room and bathroom was being use by the new property owner, window screen was ripped Courtyard; LPAs observed, wires hanging from the roof, unorganized tables and chairs Backyard and side yard; LPAs observed screen door leaning on fence, the side of the shed had garbage bags, ladder laying on the pathway, multiple chairs observed in front of the shed, LPAs observed deck with multiple wood constructions, uneven pavement Due to time constraint component III was not completed, LPA will re-visit facility. LPA is not recommending facility for license until all deficiencies are cleared from facility . This Pre-Licensing report will be submitted to the Central Application Branch (CAB) for review. Exit interview conducted with Applicant/Administrator.