Pre-licensing visit·April 11, 2023

Licensing Program Analyst (LPA) Lydia Martinez conducted an announced visit for the purpose of conducting a Pre-Licensing inspection. LPA met with Applicant (AP) Gladys A. Ambion and a tour of the inside and outside of the facility was completed. Facility is to operate a Residential Care Facility for the Elderly (RCFE). The Application was submitted to Community Care Licensing on 10/27/2022. Facility is an existing facility, undergoing a Change of Ownership. There are 6 Non-Ambulatory Residents in care under the current license. Facility is a one story, 7 bedroom, 6 bathroom home with an attached garage that is used for storage. There are 2 extra rooms by the garage that may be used as office/den, anything other then bedrooms. There is also a detached guest house that is not to be used or Residents and is currently used for storage. Facility will have live-in staff. Adequate seating is available in the dining room as well as the living room. Bedrooms are provided with furniture in good repair, clean linens, adequate storage space, and kept hazard free. Bathrooms were observed to be in good repair, toilets were operational, and non-skid floor mats are provided. Facility has an adequate supply of linens. Facility met the minimum 2-day perishable and 7-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to the residents in care. Facility had back-up emergency food and water supply. Smoke and carbon monoxide detectors are centrally wired and are operational. Facility is equipped with Fire Sprinklers. Fire Extinguishers are mounted and charged. Stove, oven, refrigerator, dishwasher, microwave, washer, and dryer are clean and operational. Toxins and disinfectants are locked and inaccessible to residents. Hot water in bathroom is within regulatory requirements. First Aid Kit contained all required items. Medication is stored in a locked cabinet. The facility has activity supplies such as exercise, board games, arts and crafts, music, and bingo. Facility has a patio cover with patio furniture. Side exit gates are unlocked and self latching. The Component III was completed during today's visit. A Fire Clearance was granted for 6 non-Ambulatory Residents on 01/10/2023. The designated AD was notified 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 sent to the email on file.