Pre-licensing visit·July 14, 2022

Licensing Program Analyst (LPA) Joseph Alejandre conducted a Pre-licensing inspection. Applicant Rozina Amlani met with LPA and granted entry. Facility is to operate a Residential Care Facility for the Elderly (RCFE) capacity is for 6 non-ambulatory residents, of which one can be bedridden. Application was submitted to CCL on 02/22/2022 . LPA and Applicant toured the facility. LPA observed: Structure . Facility is a single story home with 7 bedrooms, 7 bathrooms, kitchen, living room and an attached 2 car garage that is being used for storage and kept locked. There is a back yard with a patio cover for the residents. Both exit gates are operational. There is a small fountain in the backyard. The fountain is raised and the depth is 1 inch. The fountain is not a safety hazard. Facility telephone number is 949-249-3708 . Resident Bedrooms . The resident bedrooms are spacious and will easily accommodate the residents and their belongings. All resident bedrooms had the required furnishings. Bathrooms all bathrooms were clean and operational. Linens & Hygiene Supplies all linens were clean and in good repair. Facility had an ample supply of hygiene items. Emergency Phone Numbers, Exit Plan & Menu : Reviewed. Food Service. two perishable and seven day nonperishable food supply observed. Carbon Monoxide, Smoke Detectors, were observed and tested operational. LPA observed the fire extinguisher in the kitchen was fully charged. Appliances . New Stove burners, microwave, washer, and dryer were observed and are clean and operational. Knives : Locked/stored in a kitchen drawer. Toxins : are stored and kept locked in the garage. Water temperature. Tested between 106.0 to 106.5 F degrees . Medication First-Aid Kit & Activity Supplies. Medication is kept locked in a hall closet. first-aid Kit and activity supplies are available and stored in the ktichen. Resident & Staff Files change of ownership no files reviewed. Fire clearance was approved by Orange County Fire Authority Inspector Francisco Martinez on 04/28/2022 . No deficiencies observed during the visit. During the visit the LPA explained the process of this application and also about post licensing visit once the facility is licensed. Applicant was informed today that the final approval will be processed by the CAU supervisor in Sacramento. Component III was waived during the visit due to applicant is a current licensee for a licensed RCFE facility and in compliance status, supervisor approved. Facility is ready to be licensed. An exit interview was conducted and a copy of this report, LIC809 was explained and provided to applicant