Pre-licensing visit·December 14, 2022

On 12/14/22, Licensing Program Analysts (LPA) M. Yang conducted an announced Pre-licensing / Component III Inspection. LPA introduced self, stated the purpose of the visit and was allowed entry into the facility. LPA met with Susan Blanza, Licensee and Petro Crisostomo, Administrator. The facility is a 5 bedroom and 3-bathroom home and fire clearance was granted for 6 Non-Ambulatory for a total capacity of 6. There are five resident present during this inspection. LPA toured the facility with Licensee and Administrator. Facility was free from ground obstructions and odor free. Common areas were observed to have adequate seating and lighting available. Kitchen was toured and observed to have dishes, plates, and utensils. Knives will be kept locked and secure in the kitchen drawer. Bedrooms were observed to have the required furnishing and are ready for occupancy. Hot water measured at 115.2 degrees F in bathroom 1 and ranged 116.2 to 119 degrees F in the bathroom in the shared bedroom. Cleaning supplies and chemicals observed to be locked in shelf in the laundry room. LPA observed an extra supply of bed linens and personal hygiene products. Medications will be locked in shelf near kitchen. A fire extinguisher was observed and had a service date of 07/12/22. Smoke detectors and carbon monoxide were observed to be operational during this inspection. First aid kit was observed and contained all required items. Outside of facility toured. Exits were open and free of obstructions. LPA observed side gate to be self-latching. Resident records were reviewed. LPA observed resident Admission Agreements, Physician Reports, and Pre-Appraisal. Component III was conducted during today's pre-licensing visit. I have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.