Pre-licensing visit·August 16, 2022

on 08/16/2022, Licensing Program Analyst (LPA) Misty Valencia arrived at the facility for announced visit conduct visit regarding Pre-Licensing and Comp lll Orientation. LPA met with Holly Suiter, Administrator and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Facility Representative and completed a facility risk assessment. LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical mask. Additionally, LPA was screened at the front kiosk. COMP II, has been completed by Centralized Application Bureau analyst who confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of property. Applicant has satisfied all requirements in accordance with Title 22, California Code of Regulations. cont on 809-C LPA toured the facility inside and out including but not limited to facility kitchen, dining room, living room, three (3) bathrooms, outside areas, and four (4) resident's rooms. All resident rooms are fully furnished, and facility has sufficient activities available for clients. All bathrooms are equipped with hygiene products and paper towels. Exits and outside area are free of obstruction. There are no bodies of water present. There are no firearms being kept at the facility. Medications will be stored and locked in a locked cabinet/drawer in the locked medication room. Smoke and carbon monoxide detectors were observed as operational. Fire extinguisher were observed as full. First aid kit was observed to be complete. Facility is ready to be licensed by Centralized Application Bureau. No deficiencies for todays visit. An exit interview was conducted and a copy of this report was emailed to Administrator.