Pre-licensing visit·June 13, 2024

Licensing Program Analyst (LPA) Elizabeth Irra conducted a scheduled pre-licensing visit. LPA met with Rocio Collado (Applicant/Administrator), Anna Aldiano (Assistant Administrator) and Lucio Collado. This facility consists of (6) bedrooms, (1) staff/employee room, (3) full bathrooms, (1) ½ bathroom, utility room (laundry), living room, dining room, kitchen. This facility is approved for (12) AMBULATORY residents only. During this visit, LPA conducted a facility tour and conducted Component III. The following was observed/inspected: Smoke detectors operate properly. Carbon monoxide detector was tested and operable. Fire extinguishers located in the kitchen and near the dining room. Cleaning solutions (under kitchen sink) and sharps are locked in the kitchen. Building and grounds are free from hazards. Beds have the required linen/supplies. Bedrooms are large enough to allow for easy passage between and comfortable for usage of beds and other required items of furniture. There are enough bath towels, hand towels and wash cloths for all residents. There are sufficient amount of linens available to permit weekly changing to ensure use of clean linens at all times by residents. Facility has a washer and dryer that are fully operational located inside the utility room. Pantry's cupboards, freezers, stoves, microwaves, refrigerator and counters are clean. Two-day supply of perishables available, seven day supply of non-perishable available. Pesticides and other toxic substances are stored and locked away from food supply. Staff and Resident files (including resident medications) will be locked inside the staff/employee room. Refer to LIC 809C for the continuation of this report. Physical plant is in good repair. Building and grounds are free from hazards. Window screens are in good repair and windows/curtains/blinds are in good repair and operate properly. Refrigerator, stove, telephone, sinks, tubs, toilets and showers operate properly. Hot water temperature measured within regulation (115.5* to 117.5*) Pending: Surveillance Cameras: Applicant to follow up with Centralized Applicant Bureau (CAB) for guidance. Hospice Waiver: Applicant to follow up with Centralized Applicant Bureau (CAB) for status. Liability Insurance (H&S Code 1569.605): Applicant has not yet purchased as license has not been issued. Facility Sketch LIC 999: to be updated accordingly (staff/employee room to be reflected). Planned Activities/87219(d): Activity schedule missing. Telephone line/87311: Per Applicant, still awaiting for provider to connect this service. First Aid Manual/87465(a)(9)(A): Manual has a copyright year of 2018. Applicant to obtain most current copy. First Aid Kit/Thermometer/87465(a)(9)(F): Kit is missing the thermometer. Grab bars/87303(e)(4): All full bathrooms are missing grab bar near the toilets. Exit interview conducted, copy of report provided to Rocio Collado/Applicant.