Pre-licensing visit·December 17, 2021

Licensing Program Analysts (LPAs) Kimberly Lyman and Kevin Saborit-Guasch made an announced visit to conduct a pre-licensing inspection. LPAs identified themselves and discussed the purpose of the visit with Administrator Aurelia Olais. An initial application to operate a Residential Care Facility for the Elderly was received by CCL on 04/09/2021 for a capacity of fifty five non-ambulatory residents. Administrator Aurelia Olais has an administrator certificate expiring on 11/22/2022. Licensee Dillon Hassan arrived during the visit. LPAs Lyman and Saborit-Guasch along with Administrator Olais toured the facility at 9:30 AM and observed the following: Structure: Facility is a one story, two building facility with a tan exterior. The exit gate is closed and equipped with delayed egress. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: Rooms are a mix of single and double occupancy. All rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Bathrooms: All resident bathrooms have a working toilet/ wash basin as well as grab bars and non-skid surface in the shower. Facility has designated shower rooms for residents. Linens & Hygiene Supplies: Linen supply is in ample supply for residents in care. Emergency Phone Numbers and Exit Plan: Available for review in the entrance area of the facility. Food Service: Facility has ample 2 day perishables as well as 7 day non-perishables in the pantry. Facility provided proof of daily temps on refrigerators and freezers. Smoke Detectors: Smoke detectors are centrally wired and tested by an outside agency. Carbon Monoxide detectors tested operational. Fire extinguishers are mounted and charged. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins / Sharps : Secured in various locations.. Water Temperature: Tested and recorded between 105 and 120 degrees F. in facility bathrooms. Emergency Supplies: LPAs observed ample emergency food and water as well as thirty day supply of PPE, soap and sanitizer. CONTINUED ON LIC 809C DATED 12/17/2021 Medications, First-Aid Kit & Book: First aid kit observed contained all required items. LPA observed completed emergency disaster plan. Medication is be stored and locked in medication cart. Facility uses an electronic medication administration record. Resident & Staff File: Records are stored in facility office. Reading Material, Games, and Equipment: Facility has ample activities including exercise, games, and movies. LPAs observed residents participating in activities during the visit. Outside Area : LPAs observed a clean outside area with ample shaded seating for residents. Fire Clearance: Approved for 55 non-ambulatory residents on 08/04/2021. Licensee to address the following and forward proof to LPA by 12/31/2021: Please remove walkers and wheelchairs from the outside walkway Please repair/ replace dresser drawers in rooms 11, 16, and 26. Please clean/ repair discoloration on walls in rooms 7 and 9. Please install handrails in the hallway of the main building. Please repair/ replace the cupboard in the sun room shower room. Component III not conducted during this visit as Licensee has been running the facility prior to the pre-licensing. The facility is not ready to be licensed. Licensee to notify LPA when corrections are completed. An exit interview was conducted with Licensee and Administrator and a copy of this report was provided.