Pre-licensing visit·August 18, 2022

Licensing Program Analyst (LPA) Katie Brown arrived at the facility to conduct the Pre-Licensing Inspection. LPA met with Administrator Sheen Ibanez. LPA began the tour by entering through the front door of the home. All required documents are displayed and observed upon entry. LPA observed Covid-19 Health Screening area and visitor sign in. Furniture and flooring in common rooms observed to be in good repair with adequate lighting throughout. Resident bedrooms have the required furnishings, lighting and bed linens. Smoke and Carbon Monoxide detectors present and in working order. LPA observed supply of extra bed linens, towels, and personal hygiene/grooming products. Hot water temperature in resident bathroom measured at 107 degrees F. LPA observed hand soap, paper towels, garbage cans and grab bars in resident bathrooms. Kitchen observed to have supply of dishes, cups, plates, utensils, pots and pans and cooking utensils in good repair. LPA observed a 7 day of non-perishable and 2 day perishable food supply. Counter tops and cabinets are clear and appropriate for food preparation. Knives are kept in a locked drawer in the kitchen. Cleaning supplies and chemicals are stored in a locked cabinet separate from any food items. A Washer and Dryer were observed with additional shelving for storage. Appliances observed to be in working order and at maintained at proper temperature. Medications are stored in a locked cabinet along with First Aid Kits. The First aid kits contained all required items. A fire extinguisher is present in the kitchen dated 10/12/2021. Doors and passageways are unobstructed throughout the home. See LIC809-C for continuation of this erport Outside of the facility toured. The home does not have a pool, bodies of water or other hazards. Outdoor activity space with shaded area and seating were located on the backyard patio. LPA observed a self-releasing gate and windows have screens in good repair. e. Component III was conducted during the visit with the Licensee and Administrator. LPA called the designated facility phone (209) 233-9334 to verify the phone is set up and in working order. The applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued. A copy of this report was provided, and an exit interview was conducted with Sheen Ibanez