Pre-licensing visit·May 1, 2025

On 5/1/25 at 9:30am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted a Pre-Licensing Inspection with the facility Administrator Tamara Aleksani. Upon arrival, LPA introduced herself by showing her department badge. This is a single story house which will be operating as Residential Care Facility for Elderly (RCFE). A fire clearance was approved on February 11th, 2025 for six (6) Non-Ambulatory residents of which one (1) may be Bedridden for bedroom #3, and one (1) Ambulatory resident for bedroom #1. Facility also received Hospice approval for five (5) residents. The smoke alarms and carbon monoxide detectors are hard wired and inter-connected, they were tested and are operational. The facility has two (2) fire extinguishers that was purchased on 10/18/2024 and is located on the kitchen wall. A tour of the physical plant was initiated at approximately 10:15am and the following was observed: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, gas stove, microwave oven and sink. LPA observed adequate supplies of emergency and nonperishable food properly stored inside the kitchen cabinets. Perishable food items are not required at this time as there are no residents in the facility. Licensee will supply sufficient amount of perishable food upon arrival of the residents. dining ware to accommodate a maximum capacity of six (6) residents. Knives and other sharps were observed locked inside the kitchen cabinet and chemicals observed stored inside locked cabinet under the kitchen sink. BEDROOMS: The facility has four (4) bedrooms and all bedrooms are designated for residents' use. All residents' bedrooms observed to be nicely furnished with beds, night stands, lamps, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and a closet space. Additional linen is available inside each bedroom’s closet. Continue on LIC809-C BATHROOMS: The facility has three (3) bathrooms, both designated for residents’ and staff use. All bathrooms were observed to have the proper fixtures, grab bars, non-skid mats, trash cans with closed lids, paper towels and washing hands signs. The hot water delivered in the bathrooms measured at 10:15am to be at 117.7 degrees F. COMMON AREAS: These includes living room and a dining room. The living room was equipped with new furniture, a television, and television stand. The dining area has a dining table to accommodate six (6) clients. There were no visible immediate hazards. The facility has comfortable temperature which was measured at 10:45am to be at 70 degrees F. LPA observed various activity supplies nicely stored inside the TV stand and ready for residents' use. LAUNDRY ROOM: The washer and dryer is located in a laundry area located in the hallway across from the kitchen. Laundry chemicals will be stored inside the separate storage area, which will always be locked and under supervision. MEDICATIONS/ Client/Staff Files: Medications and facility files will be kept inside the locked storage cabinet next to the facility entrance door. First Aid and the new manual is also locked inside the same cabinet. LPA observed the First-aid has all proper items and is current. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home were clear of obstruction. The backyard of the facility is properly fenced, has a patio and backyard furniture to accommodate six (6) clients. Facility is sharing the area with another house located in the same property. Both houses are separated with proper fencing, have no access to each other’s space and have separate addresses. GARAGE: There is no garage in the property. Continue on LIC809-C LPA observed the facility is clean, safe and sanitary. All window screens were in good repair. Auditory signals were installed on exit doors. All passageways were free of obstruction. In addition to the Pre-Licensing inspection, a Component III power point presentation was also held. Pursuant to Title 22, CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised. An emergency exit plan/sketch along with other posting requirements were available and posted on the wall. No deficiency cited on today’s visit. Exit interview conducted and copy of this report signed and delivered to the Administrator.