Pre-licensing visit·December 10, 2021

Licensing Program Analyst (LPA) Joseph Alejandre made an announced visit to conduct the pre-licensing inspection. LPA was greeted and granted entry by applicant Ashkan Bastani. Facility is to operate a Residential Care Facility for the Elderly with a capacity of 6, with hospice waiver for 4. Fire clearance allows for 1 bedridden resident in bedroom number 3 only. Application was submitted to CCL on 11/04/21 . Facility telephone number is 949-487-0655. Facility is a single story home with 5 bedrooms and 2 bathrooms and a 2 car attached garage. LPA and Applicant toured the facility . Backyard; The backyard has a table and chairs to sit outside. Both exit gates are operational. No bodies of water observed. No obstacles or hazards observed. Bedrooms Residents . The resident bedrooms are spacious and will easily accommodate the resident's furnishings. All resident bedrooms had the required furnishings. Bathrooms . both were clean, faucets and toilets were operational. Hot Water temperature measured between 108.0 degrees Fahrenheit to 110.2 degrees Fahrenheit. Living Room; LPA observed the fireplace is screened. The living room has chairs and a sofa along with a TV for residents. Linens & Hygiene Supplies . Clean linens were observed. Emergency Phone Numbers, Exit Plan & Menu : Reviewed. Kitchen LPA observed a 2 day supply of perishable food and 7 day supply of non-perishable food on hand. The kitchen was clean and organized. LPA observed the knives and sharp objects are kept locked in a kitchen drawer. Carbon Monoxide, Smoke Detectors, Fire Extinguisher smoke detectors/carbon monoxide detectors tested operational. Fire extinguishers were fully charged. LPA observed the Medication cabinet is locked . First-Aid Kit & Activity Supplies. LPA observed the first-aid kit has all the required elements. Resident & Staff Files no files reviewed. Fire clearance was approved by Orange County Fire Authority Inspector Michael Longbardo on 11/15/21 . During the visit LPA explained the process of this application and also about post licensing visit once the facility is licensed. Component III was completed with the applicant. No deficiencies observed, facility is ready to be licensed. Applicant was informed today that the final approval will be processed by the CAB unit in Sacramento. An exit interview was conducted and a copy of this report, LIC809 was explained and provided to applicant.