Pre-licensing visit·February 16, 2023

Licensing Program Analyst (LPA), Lydia Martinez conducted an announced visit at this facility for the purpose of completing a Pre-Licensing evaluation. Facility is an existing facility and undergoing a Change of Ownership. There are 6 residents in care under current license. An application to operate a Residential Care For the Elderly (RCFE) was submitted to the Central Applications Unit (CAU) on 07/28/2022 for a capacity of 6 residents. A Fire Clearance was granted for 6 non-ambulatory of which 1 can be bed ridden (bedroom 5) on 01/23/2023. LPA met with Applicant Albert Pimentel and Administrator Donnavee C. Lalap. Facility is a 6 bedroom downstairs, 2 staff bedrooms upstairs, 4 bathroom, two story house. LPA toured the entire premises. Fire extinguishers were mounted and charged. Smoke detectors have been tested. There was a locked area for medications. Sharps were stored in a locked kitchen drawer and toxins and cleaning supplies were locked under kitchen sink and also stored in the garage. Beds are made with appropriate linens. Furniture appeared safe and adequate. Hot water in bathrooms is tested and is within regulatory requirements. This applicant has also submitted a request for a Hospice Waiver and a plan to care for residents with Dementia. Component III was waived during the visit due to applicant is a current licensee for 7 RCFE's and they are in substantial compliance. The Pre-Licensing is complete and this facility has no deficiencies. All elements verified by LPA appear to be in compliance and the facility is ready to be licensed. The license will be granted upon completion of a final review and approval from the Application Specialist. An exit interview was conducted and a copy of this report will be emailed to email on file.