Pre-licensing visit·August 21, 2024

At 10:30am, Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an announced Pre-Licensing visit to this facility and met with the Administrator. This is an initial application. The purpose of today’s visit is to inspect the facility to ensure that it maintains compliance under 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: Facility Fire clearance was conducted on 06/11/2024 and approved for five (05) non- ambulatory residents and one (01) bedridden resident . The facility has dual carbon monoxide and smoke alarm system. There is a fire extinguisher located in the kitchen with a date of purchase of 03/2024. There will be a functioning telephone on the premises. An emergency exit plan/sketch is posted in each bedroom and in the hallway wall with other posting requirements. There are three (03) bedrooms designated for residents use. Residents bedrooms were observed to be appropriately furnished. There are three (03) bathrooms in the facility. Bathrooms have non-skid mats and appropriate grab bars. Trash cans were observed to have closed tight fitting lids. 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. Resident, staff records and medication will be stored in a locked cabinet in the dinning room. There is one (01) first aid kit. The kitchen knives are stored in a locked drawer. Cleaning supplies and toxic chemicals are stored in a locked cabinet underneath the kitchen sink. Laundry detergents, cleaning supplies and other toxins are stored in the garage. LPA observed the garage to be locked and inaccessible to residents in care. Facility appears to be clean and in good repair. Appliances in the kitchen are new and functional. There will be a sitting area in the backyard for residents to conduct outdoor activities. The outdoor, front and back yards were free of any obstruction. There is no body of water. Component III was conducted with applicant. No deficiencies issued with this report. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. Exit interview was conducted. A copy of this report was signed and delivered.