Pre-licensing visit·October 24, 2024

Licensing Program Analyst (LPA) Lydia Martinez made an announced visit to conduct a Pre-Licensing inspection. LPA identified herself and was granted entry into the home. An initial application to operate an Residential Care Facility for the Elderly (RCFE) was submitted to Community Care Licensing on 07/01/2024 for a capacity of six (6) Residents. Applicant Emelyn Asis has an Administrator certificate valid until 03/12/2025. Upon entry, facility appears clean, safe and sanitary. LPA along with Applicant toured the facility and observed the following: Structure: Facility is a one story, 5 bedroom, 3 bathroom house with an attached garage. Livin g Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Resident : Two rooms will be single occupancy and other two will be double occupancy. All rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Bathrooms: Resident bathrooms have a working toilet/wash basin. Facility has sanitizer/soap in the bathrooms. Linens & Hygiene Supplies: Facility has adequate bedding, towels and hygiene supplies for Resident in care. Emergency Phone Numbers and Exit Plan: Emergency plan/phone numbers will be located in facility entrance. Food Service: Applicant understands to have a 2 day supply of perishables and a 7 day of non-perishables at all times when Residents are present. There are no Residents present during this inspection. LPA observed ample emergency food and water as well as a facility menu. Smoke Detectors: Smoke detectors/carbon monoxide detectors are hard wired and were tested operational. Fire extinguishers is mounted and charged. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins / Sharps : Facility has secured area for toxins/sharps under kitchen sink. Water Temperature: Tested and hot water temperature was within regulatory requirements. (cont...LIC809C) Medications, First-Aid Kit & Book: First aid kit observed contained all required items, including First Aid Manual. Facility to be stored in Medication cabinet located in living room and will use a Medication Administration record. Resident & Staff File: Records to be stored in a locked medication cabinet. Reading Material, Games, and Equipment: Facility has a variety of board games, music, books, and magazines. Backyard : LPA observed a clean backyard with umbrellas over seating for Residents and visitors. Exit gates observed unlocked. Fire Clearance: Approved on 08/02/2024. Rooms 1, 2, 3 non-Ambulatory, Room 4 Ambulatory and Room 5 for Caregiver. The Applicant is an existing Licensee and has completed the Component III in the past. Component III will be waived during today’s visit. Applicant demonstrates and exhibits a clear concise comprehensive knowledge of medication protocols, documentation, and wound preventative care. The Pre-Licensing evaluation has been completed. It appears this facility meets the requirements for licensure. The license will be granted upon completion of a final review and approval from the Application Specialist. An exit interview was conducted with Applicant. This report will be sent to email on file.