Pre-licensing visit·June 6, 2023

On 06/06/23, 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 Licensee (L1) Bongani “Peter” Mazibuko and Licensee 2 (L2) Sarah Mazibuko. LPA toured facility with L! and L2. Administrator (A1) Realiza Angeles arrived shortly during tour. The facility is a 3 bedroom and 2 bathroom home and fire clearance were granted for 5 Non-Ambulatory and 1 bedridden for a total capacity of 6. Facility temperature is observed set to 67 degrees F. Common areas were furnished and had adequate seating and lighting available. A fire extinguisher was observed and has a service date of 03/07/23. Medications will be kept lock in hall closet and inaccessible to residents in care. First aid kit was observed and contained all required items. Kitchen was toured and observed to have dishes, plate, and utensils. LPA observed a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. Knives were observed to be locked and secure in kitchen drawer. LPA observed an extra supply of bed linens and personal hygiene products. Cleaning supplies and chemicals were observed to be in a locked cabinet in the garage and under kitchen sink. All Bedrooms were observed to have required furnishings with adequately lightening. Bathroom observed with nonskid mat and grab bars. Hot water temperature 114.4 to in bathroom 1 and ranged between 119.4 degrees F to 119.2 degrees F in bathroom in the shared bedroom. Outside of facility toured. LPA observed adequate seating available for residents. Exits were open and free of obstructions. LPA observed side gate to be self-closing and self-latching. Smoke detectors and carbon monoxide detectors were observed to be operational during this inspection. Facility phone number: 661-501-1439. 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.