Pre-licensing visit·October 9, 2023

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection (change of ownership) with clients in care. LPA arrived at the facility at 8:40 am and was greeted and granted entry by designated Administrator (AD) Celfa Aronne. An application to operate a Residential Care Facility for Elderly (RCFE) for (6) capacity, (0) ambulatory, (6) non-ambulatory, and (0) bedridden clients was received by Community Care Licensing (CCL) on 6/28/2023. Structure: The facility is a one-story home with four resident bedrooms, two bathrooms, two staff rooms, living room, kitchen, dining room, activities room, an attached one car garage and backyard. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the living room. There is a back yard with two exit gates. The facility has one shaded seating area. LPA did not observe any obstacles or hazards in the backyard. Client Bedrooms: All resident bedrooms had the necessary furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. Toxins: LPA observed chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to client and will be stored and locked under the kitchen sink and in the garage. Medications, First-Aid Kit & Book: Medication is stored in a locked cabinet in the hallway. The First Aid Kit is mounted on the wall in the entryway. The facility was advised to print out a copy of the 20-page American Red Cross PDF Manual. Resident & Staff Files: Records are kept in the closet with the medication. LPA reviewed two staff files and two out of four resident files. Fire Extinguisher: LPA observed the fire extinguisher to be fully charged as indicated by the arrow pointing in the green zone. LPA observed the service tag on the fire extinguisher which indicates it was last serviced on 12/9/22 Reading Material, Games, Equipment & Materials: The facility has coloring books, puzzles, exercise equipment and planned group activities. Fire clearance: Was approved by a fire inspector of Orange County Fire Authority on 08/01/2023. Component III: Information provided about how to operate the facility within compliance and reporting requirements. Bathrooms: The bathrooms have working plumbing. Hot water measured at 113 degrees Fahrenheit in both bathrooms Linens & Hygiene Supplies: A supply of extra linen and hygiene supplies are stored in the hallway closet Emergency Phone Numbers, Exit Plan & Menu: Posted and available for review Food Service: There is 2-day supply of perishable food and a 7-day supply of non-perishable food on hand. Smoke Detectors: Smoke detectors were observed to be dual Smoke & Carbon Monoxide detectors that are stationed throughout the home. The dual detectors were tested and observed to be operational. Appliances: Gas four burner stove with 1 oven, 1 refrigerator, dish washer, microwave, washer, and dryer are operational. Administrator stated that they are working with the previous owner to remove the unused appliances in the garage. Residents do not have access to garage. The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. Exit interview was conducted and a copy of this report was provided to designated AD.