Pre-licensing visit·July 20, 2021

Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an announced Pre-Licensing visit to this facility for a Change of Ownership and met with applicant Daniel Cho, Administrator. Currently there are 5 non-ambulatory residents in care. Visit was conducted on 7/20/2021. Component three was also conducted on 7/20/2021. LPA Valenzuela conducted a tour of the physical plant with the applicant. Both the inside and outside of the facility were inspected. LPA inspected the facility for fire safety, personal accommodations and services, medication procedures, and food service. Facility has 5 bedrooms, four (04) rooms are private rooms and one (01) room is shared. Fire clearance is approved for five (05) non-ambulatory and one (01) bedridden resident. There are 3 bathrooms. All bathrooms have the required grab bars for showers and toilets. LPA observed bedrooms and bathrooms to be clean. Bedrooms had appropriate linens on the beds, appropriate window coverings with screens, and appropriate furniture. Hot water was observed by LPA and administrator at 120 degrees F. The facility smoke alarm system and carbon monoxide is operable. Medications are locked in kitchen cabinets,, chemicals are stored in locked laundry room and knives are in locked kitchen drawers. Emergency telephone numbers are posted on the kitchen wall along with other required posters. There are no bodies of water on the premises. There is a working telephone as well. LPA toured all common areas. LPA observed the home to be clean and furniture to be in good condition. LPA did not observe any obstructions throughout the facility. Files were observed to be locked in a file cabinet in the closet. The patio had a covered area for outdoor sitting and activities. Exit interview conducted and a copy of the report was provided. LPA will notify Centralized Application Unit regarding the component three being complete along with the pre-licensing visit being complete.