Pre-licensing visit·July 28, 2021

Licensing Program Analyst (LPA) Vasallo conducted a prelicensing visit. LPA met with applicants Tiffany and Josiah Vander Poorten. The applicant is a current licensee and therefore a component III is not required. The facility is currently licensed as Adora Hills Lone Hill 198602942. This is a change of ownership and there are currently 6 residents in the facility. The fire clearance has been approved for 6 non-ambulatory residents and 0 bedridden residents. The applicant has requested to care for dementia residents and has submitted a waiver for 6 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. There are 2 carbon monoxide detectors in the hallway. The garage was observed to only be used for storage. The garage has extra emergency water, refrigerator, freezer, washer and dryer. Medications are stored in a locked cabinet in the family 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 4 bedrooms for residents and 0 staff bedrooms. 2 of the resident bedrooms are shared rooms, and 2 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 non-slip mats. There is sufficient lighting throughout the home including common areas and resident bedrooms. There is a fire extinguisher near the kitchen and another near the garage. The hot water temperature was 116 degrees, which is within the required 105 - 120 degrees. 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 kitchen cabinet and in the garage. The stove has child proof knobs to make it inaccessible to residents. The backyard has a shaded patio area with patio furniture. There is a pool that has a fence around the entire perimeter. There is also a fish pond that has a net on top to make the body of water inaccessible to residents. The home has all the required posters. There are no cameras inside the facility. Facility files were randomly chosen for review since the facility is currently operating. The files reviewed were complete. Per California Code of Regulations, Title 22, the facility meets the physical plant requirements. Exit interview held and a copy of the report was provided to applicants.