Pre-licensing visit·August 27, 2025

At 10:00 am Licensing Program Analyst (LPA) Tihesha Smith conducted an announced pre-licensing visit with the licensee and administrator. Identification of the Licensee and administrator was verified by photo ID.The facility has a capacity of six (6). Application received for six (6) Non-ambulatory. 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. New refrigerator, no food currently but plenty of water. The appliances in the kitchen appeared to be functional. The living room has a television and comfortable furniture. Games and activities for residents stored on living room shelf. There is one (1) wall mounted fire extinguisher in the kitchen/dining room and observed to be fully charged. Dual Smoke and Carbon Monoxide detectors were observed all over the facility, tested, and observed to be operational at time of visit. There is no smoke detector in the kitchen. No emergency exit plan/sketch is posted near each entrance/exit wall with other posting requirements. There are two (2) bathrooms in the facility. The Hot water was tested for resident bathroom and measured to be between 113.0 and 116.0°F. Bathrooms have trash cans with lids and bathroom and has suction cup grab bars. (Cont from 809) There are three (3) shared resident bedrooms and no room is designated for staff use. Extra linen stored in resident closets and hallway closet. The sharps are stored and locked in a drawer in kitchen. Medications and facility files to be stored in the locked standalone cabinet in living room. Toxins locked under bathroom sink. The first aid kit on living room shelf The necessary precautions have been made to the facility to safely house dementia residents such as auditory alarms on all entry/exit doors and locked areas for centrally stored medications. Facility appears to be clean and in good repair. Patio in back. Patio furniture with umbrella to have sufficient seating for residents to conduct outdoor activities. Laundry is in hall closet and appliances are observed to be in good repair. There is no body of water on the facility. Component III was conducted with the administrator and understanding Title 22 confirmed. The following items need to be addressed prior to licensing: Grab bars need to be mounted/no suction cups Permit for building conversion (Garage/ADU) Posted Facility Sketch at entry/exit with shutoffs clearly noted Covered Patio furniture set up photos Smoke detector in kitchen photos This report will be forwarded to the Centralized Application Bureau (CAB). Exit interview was conducted and a copy of this report was provided.