Pre-licensing visit·March 20, 2025

On 03/20/25, Licensing Program Analyst (LPA) M. Yang conducted an announced Pre-licensing and Component III inspection. LPA introduced self, stated the purpose of the visit, and met with Licensee/ Administrator Leticia Jackson. The facility is 4 bedroom and 2-bathroom home. Fire clearance was granted for 6 Non-Ambulatory for total of 6 capacity. All four residents were present during this inspection. LPA toured the facility with Licensee. Facility temperature is set to 70 degrees F. Common areas were furnished and had adequate seating and lighting available. A fire extinguisher was observed and has a service date of 07/20/24. Kitchen was toured and observed to have dishes, plate, and utensils. Medications were kept locked and inaccessible to residents under television stand. Medication was checked and MAR were reviewed. Refrigerator temperature maintained at 35 degrees F. LPA observed a 2-day supply of perishable foods and a 7 day supply of non-perishable foods. First aid kit was observed and contained all required items. Knives were observed to be locked and secured in kitchen drawer. Cleaning supplies and chemicals were observed to be in a locked laundry closet. LPA observed an extra supply of bed linens and personal hygiene products. All bedrooms were observed to have required furnishings. Bathrooms toured. All bathrooms are observed with securely fastened grab bars and non-skid mat. Hot water measured at 109 degrees F in bathroom master bathroom and 109.9 degrees F in the hall bathroom. Outside of observed side gate to be self-closing and self-latching and with adequate outside seatings. Smoke detectors and carbon monoxide detectors were observed to be operational during this inspection. All residents record reviewed to have Admission Agreements, Physician Reports, Pre-Appraisal, and Emergency Identification Information. All staff records were reviewed to have a criminal record clearance. Facility phone number 661-491-3032. 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.