Pre-licensing visit·September 20, 2022

Licensing Program Analyst (LPA) Jerome Haley made an announced visit for the purpose of a pre-licensing evaluation. LPA Haley was greeted and granted entry by applicant Margie Santos. Upon entry, LPA Haley was temperature screened and signed in at the entrance. LPA Haley observed a COVID screening station near the entrance of the facility equipped with a temperature thermometer, hand sanitizer, surgical mask, and sign in sheets. An initial application to operate an Residential Care Facility for the Elderly, for a capacity of 4 non-ambulatory residents was submitted to CCL on 3/14/2022. Structure: The facility is a single level structure, with an attached garage. There are four resident bedrooms, one living room, and one dining room. Resident bedrooms are spacious and equipped with the required furnishings: bed, lamp, chair, and storage space. Backyard/Exterior: There is a large back yard with 2 exit ways on each side the house with shaded seating area for residents. There's a locked storage shed in the backyard used for storing miscellaneous items. Air/Heating: Central air/heating system installed with a central panel to control entire house. Bedrooms Residents: All bedrooms are for non-ambulatory residents and have sliding glass exit doors for 4 non-ambulatory residents. Bedrooms # 1 & 2 are connected and share an exit door. CONTINUED on LIC809-C Bathrooms: Bathroom one is equipped with a working toilet, wash basin, and walk in shower. Hot Water Temperature in Bathroom #1 was measured at 112.8 degrees Fahrenheit and 109.2 degrees Fahrenheit in bathroom #2. Linens & Hygiene Supplies: Adequate supply of linen was stored in a cabinet in the kitchen/dining room. Hygiene supplies are stored in a cabinet above the washer and dryer Emergency Phone Numbers, House Rules, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed, House Rules and a Menu posted near the refrigerator in the kitchen. Food Service: An adequate supply of 7-day non-perishable and 2-day supply of perishable items were observed in the kitchen. There was an extra supply of perishable food items stored in the garage. Smoke Detectors: Smoke detectors are hardwired and tested operational. Appliances: Gas 5 burner stove, single oven, 2 refrigerators (kitchen and garage), dish washer, microwave, washer, and dryer are clean and noted to be operational. Toxins: All toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents are stored in a locked cabinet above the washer and dryer. CONTINUED on LIC809-C Medications, First-Aid Kit & Book: Medication and first aid kit are stored in a locked cabinet near the facility entrance and inaccessible to residents. Resident & Staff Files : Resident files and staff files are kept in a locked closet near the entrance of the facility and inaccessible to residents. Bodies of water: No bodies of water were observed. Fire Extinguisher: Observed full charged and mounted in the kitchen. There is an additional fire extinguisher located in the garage. Fire clearance: Orange County Fire Authority granted the Fire Clearance July 22, 2022 Component III: Was presented to applicant Margie Santos during the visit. No corrections need to made at this time. The facility will be recommended for licensure. An exit interview was conducted and a copy of this report was provided to applicant Margie Santos.