Pre-licensing visit·January 31, 2023

On 01/31/2023, Licensing Program Analyst (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 Administrator (ADM) Socorro Ann Telmo. The facility is a 5 bedroom and 2-bathroom home and fire clearance was granted for 5 Non-Ambulatory and 1 Bedridden for a total capacity of 6. There are 5 residents present during this inspection. LPA toured the facility with ADM. Facility was free from ground obstructions and odor free. Common areas were observed to have adequate seating and lighting available. A fire extinguisher was observed and had a service date of 03/22/22. Kitchen was toured and observed to have dishes, plates, and utensils. Knives will be kept locked and secure in the kitchen shelf. Medications will be locked in kitchen cabinets. Freezer maintained at temperature 0-degree F and refrigerator maintained at temperature 37-degree F. First aid kit was observed and contained all required items. Cleaning supplies and chemicals observed to be stored and locked in garage cabinet. Hot water temperature ranged between 114 to 119 degrees F. Bedrooms were observed to have the required furnishing and are ready for occupancy. LPA observed an extra supply of bed linens. Outside of facility toured. Exits were open and free of obstructions. LPA observed side gate to be self-latching. Smoke detectors and carbon monoxide were observed to be operational during this inspection. All residents’ records reviewed to have updated emergency contact information, Pre-Admission Appraisal, Admission Agreement, and Physician Report. Staff records were reviewed to have personnel records, Criminal record clearances and current First Aid/CPR certification. 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. A copy of this report was provided to Administrator.