Pre-licensing visit·December 17, 2024

Licensing Program Analyst (LPA) Claudia Gutierrez made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA met with Licensee Macrina Jabonero. An application to operate a Residential Care Facility for the elderly (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden residents was received by CCL on June 13, 2024. Structure: The facility is a one-story house with four resident bedrooms, two staff rooms, three bathrooms, one living room, one kitchen, and one dining room. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the entranceway. There is a backyard with an exit gate each side of the house. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard. Resident Bedrooms All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. Signal system There is a signal system. Signal system generates an audible sound and identifies the bedroom of each resident. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored and locked underneath the kitchen sink. Resident & Staff Files : Records will be kept in a locked cabinet. Medications, First-Aid Kit & Book: Medication will be stored in a locked cabinet. First aid kit is stored in one of the staff rooms and has all the required elements. Pool/Jacuzzi: No bodies of water were observed. Fire Extinguisher: Fire extinguisher is fully charged. Reading Material, Games, Equipment & Materials: The facility has reading books, board games, and other recreational materials for resident use stored in a cabinet in the dining room. Fire clearance: Was approved by a fire inspector of the Anaheim Fire Department on July 18, 2024. Special conditions noted, “Bedridden in room #4.” Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements. Bedrooms Staff: There are two staff rooms. Bathrooms: All bathrooms have working plumbing. Hot water measured between 115.1- and 120.1-degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen was stored in a closet. Emergency Phone Numbers, Exit Plan & Menu: Posted and available, means of exiting, and emergency phone numbers. Food menu is available for review in menu binder stored with resident activity supplies. Food Service: A supply of 2-day perishable and 7-day of non-perishable food will be maintained on hand. Smoke Detectors: Smoke detectors and carbon monoxide detectors tested operational. Appliances: Gas burner stove, dishwasher, refrigerator, microwave oven, washer, and dryer are operational. The Licensee was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted and a copy of this report was provided to Licensee.