Pre-licensing visit·March 19, 2024

Licensing Program Analyst (LPA) Andrea Mendivil made an announced visit to conduct a pre-licensing inspection. LPA identified themselves and discussed the purpose of the visit with Licensee Maria Jasmin Avila an initial application to operate a Residential Care Facility for the Elderly application was received by CCL on September 8, 2023 for a capacity of six residents 5 non-ambulatory and 1 bedridden. LPA Mendivil along with Licensee toured the facility at 9:05AM and observed the following: Structure: Facility is a single story, 7 bedroom, 3 bathroom house with an attached garage and an off white exterior. The exit gates are unlocked and self latching. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: All 6 residents rooms are for single occupancy. 1 staff bedroom was observed. All of the rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Bathrooms: Resident bathrooms have a working toilet/ wash basin. Staff bathroom has a working toilet/wash basin. . Linens & Hygiene Supplies: Facility has bedding and towels for residents in care. Emergency Phone Numbers and Exit Plan: Posted in dining room of the facility. Food Service: Licensee has 2 day perishable and 7-day nonperishable foods. Smoke Detectors: Smoke detectors/ carbon monoxide detectors were tested and operational. Fire extinguisher present in entry of facility. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins / Sharps : LPA observed a secure area for sharps and toxins. Water Temperature: LPA tested hot water and it read as following: residents bathrooms read at 111.3 and 117 degrees, , residents sinks in bedrooms #1 and #2 read at 109.7 and 106.1 degrees kitchen read at 108.1 degrees. Emergency Supplies: LPA observed supply of emergency water and food. Medications, First-Aid Kit & Book: First aid kit observed contained all required items. CONTINUED ON LIC 809C DATED 03/19/2024. Medication is stored in a locked kitchen cabinet. Facility to use a medication administration record . Resident & Staff File: Records are stored in a locked cabinet.. Reading Material, Games, and Equipment: . LPA observed games and books in facility. Backyard : LPA observed a shaded area for residents. Fire Clearance: Approved for 5 non- ambulatory and 1 bedridden resident on November 9, 2023. Facility is ready to be licensed. Component III completed. Exit interview conducted and a copy of this report was left at the facility.