Pre-licensing visit·January 6, 2025

At 9:30 AM Licensing Program Analysts (LPA), Leslie Ngo-Castaneda conducted an announced pre-licensing visit to the above facility and met with administrator . Fire Clearance was approved on 10.9.2024 for a maximum capacity of five (5) non-ambulatory residents and one (1) bedridden. 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 team touring the physical plant inside and outside and observed the following: KITCHEN: The kitchen is equipped with a refrigerator, microwave oven and sink. At 9:36 AM, LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. FIRE EXTINGUISHER was last purchased on 10/1/2024 is located in the kitchen. First-aid is complete and new. BEDROOMS: There are five (5) bedrooms designated for client use. All bedrooms are furnished with beds, dresser and required bedding and linen. Extra linen is available in the hallway cabinet. The bedrooms have sufficient closet space and have sufficient lighting. Facility will have awake staff. Bedroom #1 is shared and is located by the kitchen and living room. Bedroom #2, bedroom #3, bedroom #4, and bedroom #5 are private bedroom located by the hallway. Continue to LIC 809-C BATHROOMS: LPA observed two (2) bathrooms are clean and in good repair. Properly supplied with toilet papers, soap, and paper towels. The hot water temperature measured between 109.1°F. Bathroom #1 is located in the hallway in between by the entrance of the facility. Bathroom #2 is located in between bedroom #2 and bedroom #3 of the facility. Hot water for bathroom #2 measured at 110.4°F. COMMON AREAS: The facility maintains a comfortable temperature at 72°F. The living room and dining appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Office is located, by the living room. MEDICATION: The medications will be kept in the kitchen cabinet and LPA observed the cabinet kept locked and inaccessible to residents in care. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 10:07 AM they were tested and observed to be operational. SURROUNDING GROUNDS: In the back of the facility has sufficient yard space. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. The backyard is fenced. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. There is a swimming pool or bodies of water in the backyard, this is lock and fenced. The driveway, passageway and entrance to the home was clear of obstructions. GARAGE – is used as a storage. LPA observed laundry room is located in the locked garage. The washer/dryer appear to be in good condition. Laundry supplies are kept lock and inaccessible when not in use with supervision. Component III was NOT conducted with the administrator and licensee. Needs further visit is required in order to meet the licensee. Facility is in compliance with Title 22 Regulations at this time. Exit interview was conducted and with a copy of this report was provided to the administrator.