Pre-licensing visit·May 1, 2024

Licensing Program Analysts (LPAs) Jerome Haley and Edward Kim conducted an announced visit to the facility to conduct the pre-licensing inspection. LPAs met with Applicant Brian Estorba and John Jason Eugenio and toured the facility. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to CCL on December 18, 2023. The facility is to have a capacity of 6, of which 5 can be nonambulatory and 1 bedridden. Facility phone number 657.214.2818. LPAs observed the following. Structure: The facility is a one story house with a 2 car garage with 5 bedrooms (1 is for staff), 3 bathrooms, dining room/living room, and a kitchen. There are 4 exits, one exit door in the kitchen, one in the hallway outside of bedroom 7, the front door and the exit in bedroom 5 which is approved for 1 bedridden resident. Air/Heating: Central air/heating system installed with a central panel to control entire house. Resident Bedrooms: There are 4 Resident Bedrooms. 2 Resident bedrooms are share and 2 bedrooms are private. The bedrooms are spacious and will easily accommodate the residents' belongings. Bedrooms Staff: Bedroom 2 is designated as the staff bedroom. 1 of 3 Continued on LIC809C Bathrooms: All bathrooms have a working toilet, wash basin and shower, except for bathroom 3 which has no shower. All bathrooms are clean. Linens & Hygiene Supplies: An adequate supply of linen was observed. 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 will be posted and available. Food Service: There are no residents living in the facility at this time. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors are hardwired and tested operational. There is fire extinguisher mounted in the kitchen. Appliances: There is one 4 gas burner and griddle stove which lights unassisted, 1 oven, a refrigerator, dishwasher, washer, and dryer. All appliances are clean and operational. Toxins: All cleaning supplies and chemicals are kept in two areas: kitchen cleaning supplies locked under the kitchen sink and all extra cleaning supplies are locked in the garage.. Water Temperature: Hot water was measured in all bathrooms. Hot water measured between degrees Fahrenheit. Hot water temperature was measured at between 143 - 146.8 degrees F. 2 of 3 Continued on LIC809C Medications, First-Aid Kit & Book: The first aid kit and the first aid manual will be stored in the locked closet in the hallway with the staff and resident files. Medications will be stored in a locked kitchen cabinet above the counter near the fire extinguisher. Resident & Staff Files : The Resident and Staff Records will be kept locked in the closet next to staff room (bedroom #2). Reading Material, Games, Equipment & Materials: None. Fire clearance: Fire Clearance approved by Anaheim Fire Department on March 26, 2024. LPAs observed the following items that must be corrected: 1) fire extinguisher did not have a service date tag, 2) backyard needs to be in good repair by removing clutter (bricks, pipes, and other items), 3) left side near the gate has several planks of wood and a wheelbarrow that needs to be cleared, 4) the garage needs the exposed wires of the sprinkler system to be covered, 5) outdoor security light needs bulbs, 6) staff bathroom toilet needs maintenance due to overflow and leaks, 7) non-slip mats in the bathrooms, 8) grab bars in both restrooms, 9) the wires from Satellite dish need to be removed or properly secured, and 10) outdoor gates need to be self-latching and self-closing. The applicant plans on making the necessary corrections and contacting LPA Haley to schedule a follow up pre-licensing inspection. Exit interview was conducted and a copy of this report was provided. . 3 of 3