Pre-licensing visit·January 28, 2025

Licensing Program Analysts (LPAs) Claudia Gutierrez and Fred Arias made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPAs met with designated Administrator (AD) Yung Lee and Assistant Administrator Darlene Lindley. An application to operate a Residential Care Facility for the elderly (RCFE) for (6) capacity, (0) ambulatory, (6) non-ambulatory, and (0) bedridden residents was received by CCL on July 1, 2024. Structure: The facility is a one-story house with four resident bedrooms, one staff office, three bathrooms, a living room, a kitchen, a dining room, and attached two car garage. LPAs 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 on each side of the house. There is a shaded seating area, and LPAs did not observe any obstacles or hazards in the backyard. Resident Bedrooms All resident bedrooms had the required furnishings. LPAs observed all beds had linens and blankets. Signal system There is no signal system. 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 locked in the staff office. Medications, First-Aid Kit & Book: Medication will be stored and locked in the staff office. First aid kit is stored with the medication and contains all the required elements. Pool/Jacuzzi: No bodies of water were observed. Fire Extinguisher: Fire extinguisher was observed to be fully charged with service tag dated December 19, 2024. Reading Material, Games, Equipment & Materials: The facility has magazines, board games and other recreational materials for resident use stored in the living room. Fire clearance: Was approved by a fire inspector of the Fullerton Fire Department on November 21, 2024. Special conditions noted, ”All rooms approved for non-ambulatory, no bedridden clients. No sprinklers required. No delayed egress or locked gates. Garage shall not be used for office, sleeping, or living unless approved by building official. Any alteration, addition, changes to structure or use, shall be approved by building official.” Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements. Bedrooms Staff: There is one staff office. Bathrooms: All bathrooms have working plumbing. Hot water measured between 111.2- and 119.8-degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen was stored in the hallway storage. Emergency Phone Numbers, Exit Plan & Menu: Posted and available, means of exiting, and emergency phone numbers. 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, refrigerator, microwave, washer, and dryer are operational. Licensee to address the following corrections: New facility sketch to be submitted to Centralized Applications Bureau (CAB) identifying bedroom being used as a staff office. The designated AD 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.