Pre-licensing visit·April 14, 2025

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) Eric Lin. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by our agency on November 1, 2024 for a total capacity of six non-ambulatory and a hospice waiver for six. The facility is a single story residence with six resident bedrooms, three resident bathrooms, a living room, a kitchen area with a nook, a dining area, a laundry room and break room. There is an Additional Dwelling Unit with a different address that resides on the property. Both buildings are on the facility sketch and have fire clearances. LPA toured the exterior of the property and observed a shaded seating area and ramp, a raised garden bed and two self-closing gates. LPA toured the kitchen area and observed that there were seven day non-perishables on hand and will stock with two-day perishables once residents are in care. Knives are secured in a locked drawer and disinfectants are stored in a locked closet. All appliances are new and are working. A First Aid Kit had all of the required elements and included a First Aid manual. Medications will be stored in a locked closet. All fire alarm and carbon monoxide detectors were operational and auditory devices on exit doors were in working order. The hot water temperature measured between 106.8 and 108.3 degrees Fahrenheit . The fire extinguisher is charged and was serviced on December 19, 2024. All bedrooms had the required furnishings with a bed, linens, chest of drawers and lighting. There are motion detector lights for hallways. (Continued on LIC 809-C) (continued from LIC 809) LPA observed the PUB 475, Emergency Disaster Plan, Theft and Loss Procedures, Personal Rights and Resident Council notices on a bulletin board near the entry way. Administrator's Certificate expires on August 29, 2026. AD Lin was advised that Administrator must always be available. AD will fill out LIC 308 with Administrative Designee or look into a full-time Administrator. 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 Licensee.