Pre-licensing visit·July 3, 2024

At approximately 9:00AM, Licensing Program Analyst (LPA) Felias arrived announced to conduct a Pre-Licensing Change of Ownership inspection visit and met with Applicant, Stephanie Ellazar. Upon arrival, LPA was informed that there are 4 residents in care. Facility received an approved fire clearance dated 01/29/2023 that allows for five non-ambulatory residents and 1 bedridden resident for a total capacity of 6 residents. Facility also has a hospice waiver for 3 individuals. LPA conducted a walk-though of facility with Applicant and observed the following: Per facility sketch, facility is a one story residence with 5 resident bedrooms, one staff room, three bathrooms, and common areas. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Facility's hot water temperatures for all sinks were within Title 22 Regulations of 105F to 120F. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. All resident rooms were furnished per regulation with a bed, lamp, dresser, chair and bedside table. Facility has sufficient items for cooking and eating. Facility has a locked cabinet located in the activity room used for centrally stored medications. Facility has indoor/outdoor areas for visiting and activities. Facility's fire extinguishers was inspected November 2023. Facility's smoke and carbon monoxide detectors were tested and operational. LPA confirmed that contents of the facility's First Aid Kit were sufficient. Component III was reviewed with Applicant. No Deficiencies or Advisories given during visit. Pre-Licensing completed. Facility is ready to be Licensed as a Residential Care Facility for the Elderly. LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status. Exit interview conducted. Copy of report discussed and provided to Applicant. Signature on form confirms receipt of documents.