Pre-licensing visit·January 23, 2025

On 1/23/2025, the California Department of Social Services (CDSS) – Community Care Licensing Division (CCLD) staff conducted an announced visit to the facility for purpose of a pre-licensing evaluation. On 04/29/2024, an application was submitted to CCLD, for Initial license for a Residential Care Facility for the Elderly to serve adults ages 60 and over. The requested capacity is for 6 non-ambulatory residents. PHYSICAL PLANT LAYOUT The facility is a one-story house located in a residential street. The home consists of 5 resident bedrooms (room 4 has a toilet, room 5 has a full bathroom), 1 staff room, 2 full bathrooms, 1 entrance room (has a fireplace with screen and fireplace gas is turned off), 1 great room area consisting of a kitchen, dining area, and a living room, and a backyard patio area with shaded seating. There is a detached garage. The facility only has access to the laundry room. The garage and the studio room is not part of the of the facility layout (licensee does not have access to the garage or studio room only property owner). MEDICATIONS There is a locked centralized storage area for resident medications. PHYSICAL PLANT Facility is clean, sanitary, and in good repair. Protective devices are in place to include non-slip material on rugs. Indoor and outdoor passageways, stairways, inclines, ramps, open porches, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. Facility temperature is between 68 degrees and 85 degrees. Stairways, inclines, ramps, open porches, and areas of potential hazard are well-lit and equipped with sturdy hand railings.. Fire Alarms and Smoke alarms operate properly. Carbon monoxide detectors operate properly. FOOD SERVICE Dining room is near kitchen. Refrigerator(s) and freezer(s) are clean and large enough for the storage of at least two (2) days of perishable foods. Freezer is 0 degrees Fahrenheit. Refrigerator is a maximum of 45 degrees Fahrenheit. A seven (7) day supply of non-perishable food is present. There are sufficient amounts of tableware, tables, dishes, and utensils. There are sufficient amounts of equipment for the storage, preparation, and service of food. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean. RECORDS There is confidential storage of personnel records at the facility. There is confidential storage of resident records at the facility. POSTINGS Mandated postings are posted. ACTIVITIES There is an Activity Coordinator who comes to the facility once a week for an hour. There is an outdoor activity space with a shaded area and furnished for outdoor use. There is at least one common room available to residents for visitors. 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. For facilities of 16 or more capacity, there is a designated laundry space. There are two operating telephones and a videoconferencing device available to residents. Emergency equipment available to residents. COMPONENT III Component III presentation was completed. No plans of correction were provided. LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to the applicant. An exit interview was conducted, and a hard copy of this report was left with the Licensee/Administrator.