Pre-licensing visit·April 24, 2023

Licensing Program Analysts (LPAs) Dwayne Mason Jr. and Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPAs met with Applicant (AP) Mary Joy Garcia, 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 10/31/2022. This is an initial application with no residents in care. During the inspection, LPAs and AP observed the following: Structure. This is a one-story home. Facility is a 5-bedroom, 3-bathroom, 1 story house with attached garage that is being used for storage. There is a back yard with a patio cover for the residents. Facility telephone number is (657) 235-8725. Resident Bedrooms. The 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Lamps, chairs, linens, and storage for each resident bedroom inspected. Staff Bedrooms. The 1 staff bedroom is spacious and will easily accommodate the staff’s furnishings. Bathrooms. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 119.4 and 119.6 F degrees. Linens & Hygiene Supplies. New linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: Reviewed. Food Service. 7 days nonperishable food supply reviewed and AP stated they will obtain 2 days perishable food prior to accepting residents. Carbon Monoxide, Smoke Detectors, Fire Extinguisher were observed and tested, including the wired smoke detectors/carbon monoxide detectors. Appliances. Stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen drawer. Toxins: observed locked in the cleaning closet and under the kitchen sink. Medication cabinet is locked. First-Aid Kit & Activity Supplies: observed and available. Resident & Staff Files. This is an initial inspection and LPAs observed storage space for resident and staff files. Fire clearance was approved by City of Costa Mesa Fire Prevention Inspector Ben Castillo on 02/07/2023. 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 AP during today’s inspection. AP will obtain liability insurance once the application is approved. During the inspection, LPAs explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed today that the facility is ready for licensure and final approval will be processed by the CAB supervisor in Sacramento. An exit interview was conducted and a copy of this report was discussed with and provided to AP.