Pre-licensing visit·September 1, 2023

Licensing Program Analyst (LPA) Ashley Calderon conducted an announced pre-licensing visit. LPA met with Applicant / Rona Lomeda for the purpose of conducting a pre-licensing inspection/ Component 3. A hospice waiver has been approved for a maximum of 6 terminally ill residents. Dementia plan of operation, Infection Control Plan and Bedridden plan was submitted to Centralized Application Bureau (CAB) Specialist and is/will be under review. The facility has an approved fire clearance for five (5) non-ambulatory residents and one (1) bedridden resident. Facility approved for total capacity of (6) six. The facility is a single story, five (5) bedroom, three (3) bathrooms (1 will be used for staff/visitors only), and has a detached garage. Home is located in a residential neighborhood in the City of Norwalk. Facility will be licensed to be a Residential Care for the Elderly, serving residents age range 60 and over. -This facility was granted a fire clearance on 3/28/23. -The physical plant was toured inside and out. At this time, LPA has determined that the home is ready and passed the pre-licensing inspection / Component 3. -Facility tour alongside with Rona Lomeda / LPA used Pre-Licensed Inspection Tool. LPA observed the following: -Night lights and emergency lights in place and maintained throughout the facility. -Passageways, stairways and doors are free of obstructions. -Signal system in place on all exit doors. -Bedrooms #1- #4 approved for non-ambulatory and Bedroom #5 approved for Bedridden. -Water temperature in bathrooms, measured between 105F - 120F. -Sufficient amount of towels and linens available to permit weekly changing, located in the hallway closet. -Laundry machines (washer/dryer) located in the garage. (Continuation on 809-C...) -Emergency supplies, flash lights, medications/ medication book, first aid kit and manual, resident and staff files will/are maintained in the closet located between bedroom #1 and #2, and is inaccessible. -Disinfectants, poisons, cleaning solutions are located locked under the kitchen sink cabinet. -Sharps locked in kitchen cabinet. -Pantry, cupboards, utensils, dishware, stove, kitchen counter, microwave, refrigerators are clean and in good condition. -Refrigerator and Freezer observed to be clean and have thermometers in place. -Small refrigerator near kitchen for future residents medication, kept locked. -Required posting readily available: Facility Sketch , Emergency disaster plan, personal rights, Compliant Contact Information , labor information and ombudsman Contact information. -All windows / window screens are cleaned throughout the home and facility is maintained in a clean, sanitary and safe condition. -Smoke detectors and carbon monoxide were tested and are operable. -Outdoor space is easily accessible, no obstructions, and no large bodies of water observed. -Storage House (Shed) kept locked for garden supplies located in the backyard. -Applicant Administration Certificate Expires: 10-06-23. -Facility/ Licensee will be advertising once licensed, facility will comply with Section: 87706 Advertising Dementia Special Care, Programming, and Environments. -Applicant Cell number: 562-569-8914 An exit interview was conducted and a copy of this report was provided to Applicant Rona Lomeda