Pre-licensing visit·October 28, 2024

Licensing Program Analysts (LPAs) Nancy Guillen, Brandon Lopez and Rose Ruppert made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPAs met with Administrator (AD) Bryant So and Licensees Maricel Nepomuceno and Allen Medina. An application to operate a Residential Care Facility for the Elderly (RCFE) for six non- ambulatory, with one bedridden resident in bedroom #3 and five residents on hospice was received by Community Care Licensing (CCL) on August 14, 2024. The facility is a one-story house with six resident bedrooms, one staff bedroom, four bathrooms, a living room/dining room, and a kitchen. LPAs observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the entranceway. There is a backyard with an exit gate on each side of the house. There is an Additional Dwelling Unit (ADU) which is permitted and a locked gate which has an empty swimming pool. There is a shaded seating area and LPAs did not observe any obstacles or hazards in the backyard. LPAs toured the facility at 9:15 AM and observed all private resident bedrooms had the required furnishings of beds, lamps, chest of drawers and chairs. Each bedroom also has a ceiling fan and a television. LPAs greeted residents and inquired about their quality of care. LPAs inspected the physical plant and observed the centralized dual smoke alarm and carbon monoxide detector were in working order. LPAs tested hot water temperatures in four of four resident bathrooms, and auditory devices worked for all exits. The hot water temperature measured between 106.7 and 109.5 degrees Fahrenheit The fire extinguishers were charged and were serviced in February and April 2024. LPAs inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand . LPAs observed sharps and knives were in a locked drawer and chemicals were secured under the sink. The medication storage and resident files were locked and a First Aid kit was observed with the required elements. (Continued on LIC 809-C) (Continued from LIC 809) LPA confirmed that administrator has a current administrator certificate which expires on May 15, 2025. Administrator and Licensees waived the Component III presentation and were notified that the final application approval will be issued by the Centralized Applications Bureau (CAB) in Sacramento. An exit interview was conducted and a copy of this report was provided to the Administrator and Licensees.