Pre-licensing visit·August 3, 2022

At 9:05am Licensing Program Analyst (LPA), Angela Panushkina conducted an announced Pre-Licensing visit to the above facility and met with Applicant/Licensee, James Contreras. This is a change of ownership application from (Facility #197607994) to (Facility ##197601301). LPA conducted an entrance interview with the Applicant/Licensee. At the time of this visit LPA observed and assessed four (4) residents present in the facility. All residents appear to be clean and groomed. Fire Clearance dated 06/09/2022 was received for five (5) non-ambulatory and one (1) bedridden resident. 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 Regulations, Title 22, Division 6. The facility is a single-story building. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: The facility has a total of five (5) bedrooms, five (5) of which are designated for resident use. Resident bedrooms were observed to be appropriately furnished. There are three (3) bathrooms in the facility and were observed to have non-skid mats and appropriate grab bars installed. The facility will have awake staff at night. The common areas (living room, kitchen and dining areas) were appropriately furnished and lighting was adequate. The living room has a television and comfortable furniture. Medications are stored in a locked cabinet in the kitchen. The fire extinguisher is also located in the kitchen and was observed to be fully charged and was last serviced on 09/30/21. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 09:30am they were tested and observed to be operational. At 9:45am the hot water was tested and measured 106.2°F. There is a functioning telephone on the premises. An emergency exit plan/sketch is posted by the entrance wall with other posting requirements. Facility appears to be clean, in good repair and kept at a comfortable temperature of 70°F. Appliances in the kitchen appeared to be functional. LPA observed enough sufficient supply of 2 days perishable foods and . Continue on LIC809-C one week of non-perishable foods on premises. The necessary precautions have been made to the facility to safely house dementia residents such as auditory alarms on all doors. Plan of operation for dementia residents was also discussed with the Applicant/Administrator. At approximately, 10:10am LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. Laundry area is located in an attached garage and kept locked and inaccessible to residents. Part of the garage is converted to the office. LPA observed an office desk and a computer. R esident and staff records are stored in a locked cabinet. Extra PPE supplies and food storage was also observed. 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. Exit interview was conducted and with a copy of this report was provided to the Applicant/Administrator..