Pre-licensing visit·April 27, 2021

Licensing Program Analyst (LPA) Joseph Alejandre conducted this announced Pre-licensing visit. LPA was greeted and granted entry by Delia Pardo. LPA and applicant Dianna Manalo conducted a tour of the facility. Facility is to operate an RCFE for up to 6 residents 4 of which can be on hospice. Application was submitted to CCL on 12/03/2020. Change of ownership, previous facility was Serenity Living. LPA observed the following: Structure. Facility is a 4 bedroom, 2 bathroom, single story house with an attached garage that is being used for storage and kept locked. There is a backyard with a sitting area for the residents. No bodies of water observed. Exit gate on each side of the house is latched and kept unlocked. Both Exit routes from backyard to the front of the house (side of house) are free from obstacles and hazards. Facility telephone number is 949-481-2444. All 4 resident bedrooms are spacious and will easily accommodate the resident's furnishings. Lamps & chairs for each bedrooms inspected. 3 of the bedrooms are private and 1 is a shared room. Bathrooms. both were clean, faucets and toilets were operational. Water temperature measured 110.8 degrees Fahrenheit and 111 degrees Fahrenheit in the second bathroom. Linens & Hygiene Supplies. new linens were observed. Emergency Phone Numbers, Exit Plan & Menu: Reviewed. Food Service. seven days nonperishable food supply and 2 day perishable food supply reviewed. Carbon Monoxide, Smoke Detectors were tested and are operational. Fire Extinguisher was fully charged. Appliances. Stove top, microwave, washer, and dryer inspected. Knives: Locked/stored in the kitchen cabinet. Toxins: observed locked in a cabinet under the sink. The garage is kept locked and used for storage. Medication cabinet is locked. First-Aid Kit & Activity Supplies, observed and available. Resident & Staff Files files not reviewed. Fire clearance was approved by Orange County Fire Authority Inspector Marco Heredia on 3/24/21. LPA observed window screen missing in private bathroom number 2. LPA observed heating/AC unit water drains into a plastic waste bin. AC/heating unit should drain into house plumbing and not be leaking. These two items must be corrected prior to completing pre-licensing inspection. During the visit LPA Alejandre explained the process of this application and also about post licensing visit once the facility is licensed. Component III was waived during the visit due to applicant is a current licensee for two licensed RCFE facilities and in compliance status, supervisor approved. An exit interview was conducted and a copy of this report provided. LPA informed applicant to contact him for the second visit once both items are corrected. Facility is not ready to be licensed. LPA informed applicant final approval will be granted by CAB specialist. Exit interview conducted and a copy of this report provided.