Pre-licensing visit·December 4, 2023

Licensing Program Analyst (LPA) Ruth Martinez conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA arrived at the facility and was greeted and granted entry by staff. LPA met with Kathy Maghbouleh, Director/Administrator. A change of ownership application to operate an Adult Residential Facility for the Elderly, age 60 years and over, for (15) capacity, (0) ambulatory, (15) non-ambulatory, and (0) bedridden residents was submitted to CCL on 05/22/2023. Structure: The facility is a two unit one-story house each as unit A and Unit B. Unit A has 4 resident bedrooms, 1 staff bedroom, 2 full bathrooms, a living room, a dining room, and a kitchen. Unit B has 6 resident bedrooms, 1 staff bedroom, 3 full bathrooms, a living room, a dining room, and a kitchen. The resident’s bedrooms are spacious and will easily accommodate the resident’s furnishings. There is a large back yard with an exit walkway on one side of the house with 2 covered seating patios for the residents. Air/Heating: Central air/heating system installed with a central panel to control entire house in each unit. Bedrooms Residents: Bedrooms will accommodate 15 residents combined in both units. Unit A will accommodate 6 residents with 2 private and 2 shared bedrooms. Unit B will accommodate 9 residents with 3 private and 3 shared bedrooms. Bedrooms Staff: Unit A bedroom #1 designated for awake-staff and unit B bedroom #7 designated for awake-staff. Bathrooms: All bathrooms have a working toilet, wash basin, and walk-in shower. Linens & Hygiene Supplies: Adequate supply of linen stored in bedroom hallway storage in both units. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Continued on LIC809-C Menus prepared one week prior and listed for food serve for one week. Food Service: Adequate supply of 7-day non-perishable and 2-day perishables are stored in the kitchen. Smoke Detectors: Smoke detectors and carbon monoxide alert systems are hardwired, were tested, and found operational. Appliances: Unit a has 5 gas burner stove, single oven, 1 refrigerator, microwave, washer, and dryer, unit B has a 4 gas burner stove, single oven, 2 refrigerators, microwave, washer and dryer. All were noted to be clean and operational. Toxins: All and any toxic chemicals, cleaning solutions and disinfectants are inaccessible to residents are stored and locked underneath kitchen sink and locked storage in both units. Water Temperature: Tested and recorded maintained at a comfortable temperature and the water temperature measures 119.8 Fahrenheit degrees in unit A and 108.9 Fahrenheit degrees in unit B in facility bathrooms. Medications, First-Aid Kit & Book: Medication and first aid kit/book are stored and locked in a storage cabinet located in kitchen in both units. Resident & Staff Files : Records will be kept locked in office space in both units. Each unit has an office space. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the resident’s use, commensurate with the plan of operation. Fire clearance: Was approved on August 29, 2023. Component III: Component three waived during visit. Applicant is Licensee/Administrator of other licensed facilities. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB in Sacramento for final review prior to license being issued. Exit interview was conducted and a copy of this report was left with the applicant.