Pre-licensing visit·August 19, 2024

Licensing Program Analyst (LPA) Jenifer Tirre visited this facility for the purpose of conducting a Change of Ownership Pre-Licensing evaluation. During visit LPA observed five residents in care. Facility is a single story residential home. LPA along with Licensee Maricel Neponuceno, Administrators Diane Mahinay and Jeff Bencito toured facility at 10:05AM and observed the following: Fire clearance approval was received on 06/24/24. Structure: Facility is a one story, 4 bedroom (two private bedrooms and two shared bedrooms) and four bathrooms house with attached garage and a beige exterior. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: All Residents bedrooms meet Licensing requirements. Bathrooms: resident bathrooms have a working toilet, wash basin, and bathtub/shower as well as grab bars and non-skid surface mats in the shower. Linens & Hygiene Supplies: Facility has adequate supply of linens, blankets and towels. Facility has hygiene products for each resident. Emergency Phone Numbers and Exit Plan: Facility has Emergency Plan posted on wall. Food Service: Facility has adequate supply of 2 day perishables as well as 7 day non-perishables in the pantry/ refrigerator, as well as ample emergency food and water supply. Smoke Detectors: Smoke detectors/ carbon monoxide detector are centrally wired and were tested operational. Facility has one fire extinguisher. Fire extinguisher is mounted and fully charged. Facility has audible alarms on all sliding/exit doors. Appliances: Facility has operating gas stove, refrigerator, microwave,washer and dryer. Toxins : LPA observed toxins secured in laundry storage area and Sharps secured in locked drawer. Water Temperature: Tested and recorded between 114.6 to 116.4 degrees F. in facility bathrooms. Reading Material Games, and Equipment: facility does exercises, music therapy, puzzles, games, books and coloring books. Medications, First-Aid Kit & Book: Facility has first aid kit present at the facility with proper components. Facility has a secured location for medications and facility files. Backyard: LPA observed the facility perimeter is secured by wall with a self latching gate on both sides of facility as required. LPA observed shaded outdoor seating. CONTINUED ON 809C Administrator's Certificate observed on wall expiring May, 15, 2026. Component III Orientation was waived during this pre licensing visit due to Licensee presently operating several facilities throughout Orange county. No deficiencies noted during todays visit. The pre-licensing visit has been completed. This location is ready for licensure. An exit interview was conducted with Licensee and Administrators and a copy of report was left at facility.