Pre-licensing visit·May 15, 2024

On 5/15/2024 Licensing Program Analyst (LPA) Lavinia Muscan met with Administrator/Applicant, Lynn Reloza, to conduct an announced Pre- Licensing visit. This application is a change of ownership. This address is currently licensed as Pine Tree Villa Facility # 097003223 . Applicant holds a current administrator certificate (#6024988740 with expiration date 3/11/2025). The facility currently has 11 residents . There are four residents on hospice. One resident on oxygen. There is a fire clearance for 10 non-ambulatory, 1 bedridden and 4 ambulatory residents at this facility. LPA toured the facility with Administrator Lynn Reloza. The food supply is within compliance, 2 days of perishable and 7 days’ worth of non-perishable food items. Smoke detectors are operational. There are (3) carbon monoxide detectors which are functioning. The Fire extinguisher was charged, serviced and functional. Grab bars were present at the toilet and in the shower. All exits were unobstructed. All toxins, medications, and sharps were locked and stored away. The disaster drill is current. The administrator's certificate is current. There is a side gate for emergency access. During today's pre-licensing inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (3) and staff files (2). All resident files contained the required paperwork. All staff files contained the required paperwork. All staff have current first aid and CPR training. Facility was clean and well organized. Facility is current on fire drills. Staff training contained the required initial training. Component III for RCFE was completed with Administrator/Applicant Lynn Reloza during today's visit. LPA will forward findings to the Centralized Application Bureau (CAB) that facility met all the pre-licensing components. Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations on today's pre-licensing inspection. A copy of this report was provided to the facility. Exit interview conducted.