Pre-licensing visit·December 17, 2024

Licensing Program Analyst (LPA) Rose Ruppert made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA met with Administrator (AD) Shirley Hills. An application for a Change of Ownership (CHOW) for a Residential Care Facility for the Elderly (RCFE) was received by our agency on August 21, 2024 for a total capacity of six; six non-ambulatory, six bedridden and approved for six residents on hospice. The facility is a one story home with four resident bedrooms, one caregiver bedroom, two bathrooms, a living room, a kitchen, a dining area, a large covered outdoor patio, and a courtyard in the center of the home. The hot water temperatures measured 117.6 degrees Fahrenheit for both bathrooms. All exiting doors had alarm notifications. There is a backyard exit gate on the side of the house that is self-latching and unlocked and there were no obstacles observed in the large backyard. LPA observed the See Something, Say Something poster (PUB 475), Personal Rights, Visiting Hours and Emergency Disaster Plan in the facility mounted on the wall in the entry area.. Resident bedrooms had the required furnishings and all beds had linens and blankets. All toxic chemicals, cleaning solutions, and disinfectants are inaccessible to residents and sharps are in a locked drawer. Medications are also stored in a locked cabinet in the kitchen. The First Aid kit has all the required elements and includes a First Aid manual book. There are two fire extinguishers that are charged and were serviced on December 10, 2024. LPA confirmed the administrator has a current certificate that expires February 14, 2025. (Continued on LIC 809-C) (Continued from LIC 809) Residents were observed in the living room watching television, one was working on a crossword puzzle, one was watching a walk through Japan series and another was resting in her bed. LPA observed the facility had more than the required two days perishable and seven day non-perishable food items. Smoke detectors and carbon monoxide detectors tested operational. This facility has a pendant call system for residents. LPA conducted the Component Three Orientation with AD. 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 to Shirley Hills, Administrator.