Pre-licensing visit·November 8, 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 designated Administrator (AD) Lady Lee. An application to operate an Residential Care Facility for the elderly (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden residents was received by CCL on July 12, 2024. Structure: The facility is a one-story house with three resident bedrooms, one bathroom, a living room, a kitchen, a dining area, and unattached two car garage consisting of one staff office and one bathroom. LPA observed the See Something, Say Something poster (PUB 475) in the facility posted on the wall in the entranceway. There is a backyard with an exit gate on one side of the house and one exit gate located behind the unattached garage. 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 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 in the laundry area. Resident & Staff Files : Records will be kept in a locked file cabinet. Medications, First-Aid Kit & Book: Medication will be in a locked cabinet. First aid kit is stored with the medication 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, activity books, arts and crafts supplies, board games, puzzles, and other recreational materials for resident use stored in the living room. Fire clearance: Was approved by a fire inspector of Anaheim Fire Department on September 26, 2024. Special conditions noted, “Bedridden in ‘back’ bedroom.” 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 no staff bedroom. Bathrooms: Bathroom has working plumbing. Hot water measured at 113.5 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 menu was posted and available. 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, washer, and dryer are operational. Licensee to address the following corrections by November 22, 2024: · New facility sketch consistent with floor plan to be submitted to Centralized Applications Bureau (CAB). Updated facility sketch must identify staff office and bathroom located in the garage. LPA will make an additional announced visit to follow-up on corrections listed above. An exit interview was conducted, and a copy of this report was provided to designated AD.