Pre-licensing visit·August 10, 2021

Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Administrator (AD) Violeta Amurao, discussed the purpose of the inspection, and toured the facility. Facility is to operate a Residential Care Facility for the Elderly. Application was submitted to Community Care Licensing on 06/08/2021. This is a change of ownership. During the inspection, LPA and AD observed the following. Structure. This is a one-story home. Facility is a 6-bedroom, 4-bathroom, 1 story house with attached garage that is being used for storage. There is a back yard with a patio cover for the clients. Facility telephone number is (714) 583-8172. Bedrooms Residents. The 5 client bedrooms are spacious and will easily accommodate the client's furnishings. Lamps, chairs, linens, and storage for each client bedroom inspected. Bedrooms staff. The 1 staff bedroom is spacious and will easily accommodate the staff’s furnishings. Lamps, chairs, linens, and storage for each staff bedroom inspected. Bathrooms. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 111 to 114 F degrees. Linens & Hygiene Supplies. New linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: Reviewed. Food Service. 2 days perishable and 7 days nonperishable food supply observed. Carbon Monoxide, Smoke Detectors, Fire Extinguisher were observed and tested, including the wired smoke detector/carbon monoxide detector. Appliances. Stove burners, microwave, washer, and dryer inspected. Knives: observed locked/stored in the kitchen cabinet. Toxins: observed in the locked cabinet in the garage. Medication cabinet is locked. First-Aid Kit & Activity Supplies: observed and available. Resident & Staff Files. LPA reviewed resident and staff files. Fire clearance was approved by Orange County Fire Authority Inspector Erik Solsvik on 07/08/2021. Backyard. Backyard exit gate is operational and unlocked. Backyard has shaded area for outdoor activities and sufficient seating for residents. Component III was completed with AD during today’s inspection. Facility is currently operating under the liability insurance of current facility CRYSTAL RESIDENTIAL CARE (306005624). AD will switch liability insurance to new facility once the application is approved. During the inspection, LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AD was informed today that the facility is ready for licensure and final approval will be processed by the CAU supervisor in Sacramento. An exit interview was conducted and a copy of this report was discussed with and provided to AD.