Pre-licensing visit·August 15, 2024

Licensing Program Analyst (LPA) Kimberly Lyman made an announced visit to conduct a pre-licensing inspection. LPA identified herself and discussed the purpose of the visit with Licensee/ Administrator Anthony Salazar. Consultant John Atencio was present as well. An initial application to operate a Residential Care Facility for the Elderly was submitted to Community Care Licensing on 04/10/2024 for a capacity of five non-ambulatory and one bedridden resident. Upon entry, facility appears clean, safe and sanitary. Facility has all required postings at entrance. Administrator Anthony Salazar has an administrator certificate expiring on 01/10/2026. LPA Lyman along with Licensee/ Administrator and Consultant toured the facility at 8:15 AM and observed the following: Structure: Facility is a one story, 4 bedroom, 2 bathroom house with a tan exterior and attached garage. The outside exit gate is closed and unlocked. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: Rooms will be single and double occupancy. All rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Linens & Hygiene Supplies: Facility has ample bedding and towels in supply. Bathrooms: All resident bathrooms have a working toilet/ wash basin as well as grab bars and non-skid surface in the shower. Emergency Phone Numbers and Exit Plan: Posted in the entrance of the facility. Food Service: Facility has 2 day perishables as well as 7 day non-perishables. Smoke Detectors: Smoke detectors/ carbon monoxide detectors are centrally wired and were tested operational. Fire extinguisher is fully charged. Facility has a fire door to hallway with bedrooms. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins / Sharps : Facility has secured areas for toxins and sharps. Water Temperature: Tested and recorded between 116 and 116.9 degrees F. in facility bathrooms. Emergency Supplies: LPA observed ample emergency food and water as well as a posted emergency disaster plan. CONTINUED ON LIC 9099C DATED 08/15/2024. Medications, First-Aid Kit & Book: First aid kit observed contained all required items including tweezers, scissors and thermometer. LPA observed a first aid manual. Medication is stored in a locked cabinet. Facility to use a medication administration record. Resident & Staff File: Records are to be stored in a secured file cabinet. Reading Material, Games, and Equipment: LPA observed a sample activity schedule with activities such as games and exercise. Backyard : LPA observed a clean backyard with ample shaded seating for residents. Fire Clearance: Approved for five non-ambulatory and one bedridden resident on 05/08/2024. Component III conducted during the visit. Facility is ready to be licensed. Exit interview conducted and a copy of this report was left at the facility