Pre-licensing visit·May 6, 2021

Due to the situation surrounding the Corona virus Disease 2019 (COVID-19), and to implement mitigation measures, Licensing Program Analyst (LPA) Tuesday Cabiness conducted a virtual telephonic pre-licensing visit with the Administrator Oliver Domingo. An application for a total of (6) residents over the age of (60) was submitted. Administrator informed LPA that a hospice waiver for (6) and dementia waiver, was requested for approval; but there was no documentation to support that. LPA requested Administrator to contact the applications unit, to verify and confirm, the waivers are included. The residence is located at 8413 Rhea Ave, Northridge CA 91324. A fire clearance was approved on March 16, 2021, for rooms 2, 3, and 4, to be occupied for residents that are non-ambulatory or bedridden. The virtual tour of the physical plant inside and out with Administrator was initiated at 1pm. The facility has (5) bedrooms, with (1) room for staff; (2) private rooms, and (2) shared rooms. Upon entry, LPA did not observe any COVID-19 postings, for screening visitors or hand washing procedures. Administrator was informed to begin the develop the COVID procedures. The exterior and interior passageways were clear of obstructions. All rooms were set up with beds, night stand, lamps, chests and drawers, chairs and closet space. There are (2 ½) bathrooms; which included non-skid mats, grab bars, and shower chair. Common areas were clean, as well as walls, ceilings, and floors. Furnishings were clean and in good repair. Resident, staff records and medications will be locked in cabinets located in the dining room area. First aid supplies were available. Knives, medication, sharps, chemicals, and toxins were stored in locked cabinets. Personal hygiene products are available. The food supply was observed with Licensing requirements. Dishes and utensils were in good repair. Appliances in the kitchen were clean and functional. Laundry equipment is in the garage, as well as chemicals and cleaning supplies. Smoke alarm/carbon monoxide system was hard wired and operating; alarms were operating on all exit doors. Fire extinguisher was fully charged. Hot water temperature was tested and measured at 109.0 Fahrenheit. There was a functioning telephone on the premises. Emergency exiting plans/sketch are posted by the front door, and all required Licensing postings were posted. Outside surrounding grounds had no obstructions and clear passageways; with a covered patio and comfortable furnishings. Gates were easily accessible. There are no bodies of water or dangerous weapons on the premises. The following suggestions were provided to Administrator for complete pre-licensing visit. 1. COVID-19 postings, and cleaning station for visitors 2. Updated LIC308 – Designee of Responsibility for Facility 3. Contact applications unit regarding dementia and hospice waiver Facility is ready to be licensed. Exit interview conducted, COMP III completed, and copy of report provided to Administrator Oliver Domingo.