Pre-licensing visit·February 13, 2023

At 10:00 am Licensing Program Analyst (LPA) Tihesha “Lynn” Smith conducted an announced pre-licensing visit with administrator. Identification of the Applicant/administrator was verified by photo ID. The facility has a capacity of six (6). Application received for (1) Ambulatory and (5) Non-ambulatory- with bedrooms #2, #3, and #4 designated for Non-ambulatory residents. Purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with the rules and regulations of California Code of Regulations, Title 22, Division 6. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: The common areas (kitchen, living room, and dining areas) were appropriately furnished, and lighting was adequate. The facility has a variety of adequate perishable and non-perishable food supply. Appliances in the kitchen appeared to be functional. The living room has a television and comfortable furniture. The sharps are stored and locked in drawer in kitchen and under kitchen sink. Kitchen cleaning supplies, laundry detergents, and other toxins are stored in locked hallway closet. Medications are stored in locked hallway closet on top shelves. Resident and staff records stored also stored in locked hallway closet. The first aid kit is readily available. There is a functioning telephone/landline on the premises. An emergency exit plan/sketch is posted near each entrance/exit wall with other posting requirements. There are four (4) resident bedrooms, designated as follows: B1: Ambulatory/Private B2: Non ambulatory/Shared B3: Non-Ambulatory/Shared B4: Non-Ambulatory/Private. No room is designated for staff use. Resident bedrooms were observed to be appropriately furnished with a bed, nightstand, a chair. Extra linen stored in each resident room. (Cont from 809) There are two (2) bathrooms in the facility: one (1) designated for residents and one (1) designated for staff. The hot water was tested for resident bathroom and measured 105.1 °F. The bathroom has non-skid mats, trash cans with lids and functional grab bars. There are two (2) fire extinguishers: one (1) is located in the kitchen attached to wall and one (1) is located in hallway attached to the wall. Both Fire extinguishers observed to be fully charged and was purchased. Dual Smoke and Carbon Monoxide detectors were observed all over the facility, tested, and observed to be operational at approximately 1:20 pm. There is a side covered patio for residents to conduct outdoor activities. There is a basement used for PPE/supplies storage locked and inaccessible to residents. The is no backyard. The garage is not attached to the house and is not part of the facility. There is no body of water on the facility. Facility appears to be clean and in good repair. Component III was conducted with the administrator and administrator confirmed understanding of Title 22. At time of visit this facility is not ready to be licensed. The following corrections must be made: · Add the additional patio Entry/Exit door to Facility sketch · Add basement door to facility sketch and Resubmit Facility sketch · Update all posted facility sketches This report will be forwarded to the Centralized Application Bureau (CAB). Exit interview was conducted and a copy of this report was provided.