Pre-licensing visit·March 20, 2025

On 3/20/2025 at 9:30AM, Licensing Program Analysts (LPAs) G. Luk and Y. Brown conducted a Pre-licensing Inspection. LPAs met with Licensees/Applicants, Dennis Mendoza and Liwayway Mendoza. LPAs toured facility including but not limited to resident's bedrooms, bathrooms, living room, dining area, kitchen, garage, and outdoor area. LPAs observed lighting in all rooms. Hot water was measured at 117 degrees F in the hallway bathroom. Facility bathrooms have grab bars and non-skid mats for the showers. LPAs observed facility have some non-perishable and perishable food supplies available. Facility will purchase additional food supplies once facility is licensed. Carbon monoxide and smoke detectors were observed in operating conditions. Fire extinguishers were observed to be full and last serviced on 3/19/2025. First aid kit was complete. The following will need to be completed before recommending licensure to Centralized Application Bureau (CAB): 1. LPAs observed bedroom 1's bed is not in good repair without box spring. 2. LPAs observed bedroom 2 is missing chest of drawer. 3. LPAs observed bedroom 2's private bathroom toilet was missing grab bar. 4. LPAs observed bedroom 3's floor near the hallway door has a section where the floor is bubbling. 5. LPAs observed facility only have furniture (a chair, night stand, a lamp or lights sufficient for reading, and a chest of drawers) for 4 residents. 6. LPAs observed facility did not have mattress pads for the resident's beds. 7. LPAs observed facility does not have a land line telephone. (Continue on LIC809C...) 8. LPAs observed LIC610E needs to be updated to address sections regarding "self-reliant", call button (B), refrigeration medications (F), and confirming location (H). 9. LPAs observed facility's dementia plan did not address behaviors such as ingestion of toxic chemicals. 10. LPAs observed facility did not have the following postings: theft & investigative procedures and personal rights. 11. LPAs observed hallway bathroom does not have a paper towel holder. Licensees/Applicants will submit proof of corrections to CCLD on/before 4/2/2025. Exit interview conducted with Liwayway Mendoza and a copy of this report provided.