Pre-licensing visit·September 2, 2021

Licensing Program Analyst (LPA) Nune Margaryan, and Glenn Trueman conducted a prelicensing visit. LPA’s met with Maria Tangonan and Laurence Tangonan. Component III was also completed during the visit. The fire clearance has been approved for 6 non-ambulatory residents of which 1 may be bedridden. The applicant has requested to care for dementia residents. A hospice waiver has been requested for 2 hospice residents. The physical plant was toured with the applicant. The following was observed: There are auditory devices on exit doors as required for dementia residents. The auditory devices were operating at the time of the visit. Smoke detectors were observed in common areas and in each resident bedroom. The smoke detectors are also carbon monoxide detectors. The fire extinguishers are fully charged. The common areas were appropriately furnished and lighting was adequate. The resident and staff records will be stored in locked cabinets located in the Administrator's office. The garage was observed. The washer and dryer are located in the garage. Medications are stored in a locked cabinet in the living room. Facility also has a complete first aid kit. Windows and doors are in good condition and there were no obstructions near doors. Windows do not have security bars. There are 5 bedrooms for residents and 0 staff bedrooms. 1 of the resident bedrooms are shared room, and 4 are private rooms. Resident rooms were observed to have the required furniture such as bed frames, dressers, chairs, lamps and sufficient closet space. The bedding was also appropriate. The facility has 3 bathrooms. The bathrooms have sufficient hygiene items. The bathrooms have the required grab bars along with the required non-slip mats. The hot water temperature was between 114.2 to 118.2 degrees, which is within the required 105 - 120 degrees. There is sufficient lighting throughout the home including common areas and resident bedrooms Dining room and kitchen observed to have room for sufficient dining capacity, and the kitchen had all necessary equipment and supplies to meet the needs of six (6) residents. Appliances in the kitchen were clean and all functional. The supply of dishes/cups are adequate. More than 7-day supply of nonperishable foods were observed. Count. 809C The backyard has a shaded patio area with patio furniture. There is no pool or other large bodies of water. The home has all the required posters including but not limited to complaint poster, labor law, Ombudsman, personal rights, emergency disaster plan, and COVID-19 required postings. The facility is in compliance with Title 22 regulations. Exit interview was conducted and a copy of the report was provided to applicant.