Pre-licensing visit·April 9, 2025

At approximately 9:15AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Pre-Licensing visit and met with Staff Member, Nancy McKee. Applicant, Tina Camaclang, arrived during visit at approximately 10AM. Applicant has applied for a Change of Ownership for an existing Residential Facility for the Elderly (RCFE) identified as Schon Hyme Rest Home (210102881 ). Facility currently provides care to older adults and has a dementia care program on file. Facility received an approved fire clearance dated 02/13/2025 that allows for a total capacity of 12 non-ambulatory residents. Upon arrival, LPA was informed that there are currently 4 residents in care. LPA conducted a physical plant walk-through. LPA observed the following: Per facility sketch, facility is a one story residence with 8 resident bedrooms, 5 1/2 bathrooms, 1 staff break room, and common areas. Facility has a separate building on-site for laundry. Facility was found to be clean with all exits free from obstruction. Facility had emergency lighting. Facility's door alarms were tested and operational. LPA observed required postings including the CCL Complaint Poster and Personal Rights. 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. 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 with a bed, lamp, dresser, and chair. Facility has sufficient items for cooking and eating. Facility has indoor/outdoor areas for visiting and activities. Facility's fire extinguishers were newly purchased and were observed to be fully charged. Facility's smoke and carbon monoxide detectors were tested and operational. LPA confirmed that contents of the facility's First Aid Kit were sufficient. Continued on LIC809C Continued from LIC809 LPA and Applicant discussed the following items: Hospice Waiver - Applicant to apply for a waiver if it's decided they want hospice care in the facility Updated Admission Agreements and Care Plans - Applicant understands that they will need to complete new Agreements and Care Plans for all residents once Facility License is approved. Complaint Poster (PUB 475) - Applicant to ensure required poster is correct size (20x26). Protective Mattress Pads - Applicant understands that mattress pads should be available on-site for resident use if requested Guardian background clearances and associations - Applicant understands that all current staff members associated to Schon Hyme Rest Home (210102881) will need to be transferred and associated to new facility license once approved. Applicant to submit proof of protective mattress pads and correctly sized Complaint Poster. Proof to be submitted to Community Care Licensing (CCL) by 04/18/2025. Component III was reviewed with Applicant. No Deficiencies or Advisories given during visit. Pre-Licensing completed. Facility is ready to be Licensed as an Residential Facility for the Elderly (RCFE). 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. Signature on form confirms receipt of documents.