Pre-licensing visit·December 18, 2023

On 12/18/23 Licensing Program Analysts (LPAs) Villegas,Gibbs, Dabuet and Iniguez conducted a pre-licensing evaluation for an RCFE (Residential Care Facility for the Elderly) Change of Ownership (CHOW). Today’s pre-licensing evaluation was conducted with House Manager Bella Lee. The licensee has applied for a license to serve (111) age range 60 and over adults. The fire clearance is approved for (111) non-ambulatory. Waiver/Granted for Hospice Care for (25). Liability insurance is active. LPA’s Villegas and Gibbs toured facility kitchen, dining Room, lounge areas, (72) Bedrooms, (77) bathrooms, basement, patios with shaded area and medication room. LPA’s observed the following during this visit: MEDICATIONS- There is a locked centralized storage area for Resident medications. PHYSICAL PLANT- LPA observed Indoor and outdoor passageways, stairways, open areas, and other areas of potential hazard are free of obstructions. The facility temperature is between 68° degrees and 85° degrees. BEDROOMS- No client bedroom is a passageway to another room, bath, or toilet. There is a bed for each client with a mattress, mattress pad, bedsprings. There is dresser and closet space for each client that includes at least two (2) drawers of dresser space per client. BATHROOMS- There are plenty of toilets and washbasins for clients, family, and personnel. There are plenty of showers for clients, family, and personnel. The hot water temperature is between 105°-120° degrees Fahrenheit. Bathrooms are located inside client bedrooms and common areas. FOOD SERVICE- The dining room is near the kitchen. The refrigerator and freezer are clean and have the capacity to store at least two (2) days of perishable foods. There is storage for a seven (7) day supply of non-perishable food. There are enough tableware, tables, dishes, and utensils. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean. RECORDS- There is confidential storage for personnel records at the facility. There is storage for Resident confidential information and records at the facility. ADMINISTRATION- The emergency exiting plan and emergency phone numbers are posted. Client Personal Rights are posted. Posting both sides of the Personal Rights form LIC 613 meets this requirement. Facility Visiting Policy is posted. A Licensing Complaint Poster is posted. There is space available for resident council meetings and resident council postings. ACTIVITIES- There is an outdoor activity space with a shaded area and furnished for outdoor use. There are at least 3 common areas available to clients for visitors. There are activities scheduled during the current month. MISCELLANEOUS- There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. There is an operating telephone available to clients. Emergency lighting and supplies to include flashlights with batteries. CORRECTIONS: Smoke Detectors: Smoke detectors in room #68 is not attached properly to the ceiling. Physical Plant: Room #31 exposed hazardous chemical spray Room#11 obstruction bed blocking access to closet Room #35 no hot water Rooms #46, #83 and #84 window screens missing. Rooms #13; #19, #44, 64, #66 and #80 cluttered Room #29, #61 (being used as storage) Room #23, #36, #43, #46, #73 and #83 no linens Room #23, #35, #7, #59 no furnishings Room #39 no doorknob Room #25 and #34 molds along the wall surfaces Room #30 locked no key accessibility. Pest Control: Roaches Room #20, Room #21, Room #22, Room #24, Room #25, Room #35 Room #34, Room #35, Room #36, Room #85 Staff Records: Fingerprint Clearances Exceptions (S2), (S3), (S7) Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders (S3), (S4), (S5), (S7) Criminal Statement (S3), (S7) Health Screening (S3) TB Test (S3) Education Verification (S2), (S3), (S5), (S7) Employee Rights (S4), (S7) Missing File (S1), (S8) Clients Records: Consent Forms (R3), (R5) Safeguard for Property/Valuables (R2), (R3), (R4) Personal Rights (R3) An exit interview was conducted, and a copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.