Pre-licensing visit·June 2, 2021

Licensing Program Analyst (LPA) Vasallo and Margaryan conducted a prelicensing visit. LPA’s met with applicant Yenny Indrawati. The applicant is a current licensee and therefore a component III is not required. The facility is currently licensed as Bethesda Care Glendora 198603083. This is a change of ownership and there are currently 4 residents in the facility. The fire clearance has been approved for 5 non-ambulatory residents and 1 bedridden resident. The applicant has requested to care for dementia residents and has submitted a waiver for 5 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. Smoke detectors were observed in common areas and in each resident bedroom. The smoke detectors are also carbon monoxide detectors. The garage was observed to only be used for storage. The garage has extra emergency water. Medications are stored in a locked cabinet near the kitchen. However, the facility does not have a complete first aid kit. The kit only had bandages. Windows and doors are in good condition and there were no obstructions near doors. There are also no security bars on the windows. There are 5 bedrooms for residents and 0 staff bedrooms. 1 of the resident bedrooms is a shared room, the rest 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 home has 3 bathrooms. The bathrooms have sufficient hygiene items. The bathrooms have the required grab bars in the shower and near the toilet along with the required skid mat. One of the toilets was missing a lid. Staff stated it was broken by a resident. There is sufficient lighting throughout the home including common areas and resident bedrooms. There is a fire extinguisher near the kitchen that was last checked in April 2021. The hot water temperature was 130 degrees F*, which is beyond the required 105 - 120 degrees. Continued on 809. All appliances in the kitchen were observed to be clean and operational. The sharp knives are located in a kitchen drawer that is inaccessible to residents. Cleaning supplies and chemicals are stored in a locked laundry cabinet in the hallway. The washer and dryer are located in the hallway laundry room. 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. There are no cameras inside the facility. Resident and staff files were randomly chosen for review since the facility is currently operating. The files reviewed were complete. The facility must correct the following items before meeting the minimum physical plant requirements: · Purchase new first aid kit · Repair/replace toilet lid · Adjust hot water temperature to be between 105 – 120 degrees. Applicant agreed to correct items by Friday (6/4/21) by submitting pictures to LPA. Exit interview held and a copy of the report was provided to applicant.