Pre-licensing visit·October 21, 2021

Licensing Program Analyst (LPA) Joscelyn Martinez and Melissa Ruiz conducted an announced Pre-Licensing visit to the facility and met with administrator Nestor Tumaliuan. This is a change of ownership application from (LIC 197600281) to (LIC 197610195). The applicant is “JRBELLA Home for the Elderly”. LPAs conducted an entrance interview with the administrator. Application was received for a total of six (6) total residents of which zero (0) are non-ambulatory and six (6) are bedridden. At the time of the visit LPAs observed and assessed 2 residents present in the facility. All residents appear to be clean and groomed. Fire clearance dated 07/28/2021 was received for six (6) bedridden residents. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulation, Title 22, Division 6. The facility is a single-story building. Today’s site visit consisted of LPAs touring the physical plant inside and outside and observed the following: The facility has a total of 6 bedrooms, 5 of which are designated for resident and 1 for staff use. Resident bedrooms were observed to be appropriately furnished. There is a total of 3 bathrooms in the facility in which 1 is designated for staff use and were observed to have non-skid mats and appropriate grab bars installed. The common areas (living room, kitchen and dining areas) were appropriately furnished and lighting was adequate. Resident and staff records will be stored in a cabinet located in the dining area. The fire extinguisher is located near the front door and kitchen area with a service date of 12/ 01/21. Dual smoke detectors and carbon monoxide detectors were located throughout the facility, and at 10:47 AM were tested and observed to be operational. At 10:55 the hot water was tested in the common bathrooms and measured between 199.7-120 degrees Fahrenheit. There is a functioning telephone on the premises. An emergency exit plan/sketch is posted by the entrance wall with other posting requirements. Medications are stored in a locked cabinet in the kitchen area. The first aid kit is readily available. Facility appears to be clean, in good repair and kept at a comfortable temperature of 73 degrees Fahrenheit. Appliances in the kitchen appeared to be functional. There is a separate laundry room that remains locked and leads to the attached garage that is being used for storage. Component III was conducted with the administrator. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and be notified by the CAB Analyst when your license has been approved.