Pre-licensing visit·May 9, 2025

Licensing Program Analyst Pre-Licensing Visit Report On May 9, 2025, Licensing Program Analyst (LPA) Samer Haddadin conducted an announced pre-licensing visit at the facility. LPA Haddadin was greeted by and granted entry by Administrator Aiko Asis. The facility is a single-story residence with four bedrooms and two restrooms. It is approved for a maximum of six non-ambulatory residents, of whom one may be bedridden, and hospice care may be provided for up to two residents. During the visit, LPA Haddadin toured the facility and inspected the physical plant. This included, but was not limited to, testing all smoke detectors, verifying hot water temperatures in all two restrooms, and testing audio devices at all exits. The hot water temperatures ranged from 106.8 to 108.9 degrees Fahrenheit, and all smoke detectors were found to be operational. The fire extinguisher was charged and had a current inspection date of March 5, 2025. LPA Haddadin also inspected the exterior of the facility and noted the absence of any bodies of water. The facility provides sufficient outdoor space for resident activities. All emergency exits were checked and found to be clear and free of obstructions. An inspection of the facility's food supply revealed a seven-day supply of non-perishable food on hand. The administrator stated that a two-day supply of perishable items would be maintained once residents are in care. Knives and cleaning supplies were securely stored in a separate cabinet in the kitchen. LPA Haddadin observed that the PUB 475 notice was posted in the required 20" x 26" size, and visiting hours were also posted. Confirmation was obtained that the administrator possesses a current administrator certificate, which expires on November 8, 2025. Component III of the licensing process was conducted with the Administrator. Medication storage and a First Aid Kit were inspected. The First Aid Kit contained all required components, and medication storage was locked and inaccessible for residents. All required department postings were observed to be displayed near the entrance. The Administrator was informed that the final application approval would be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted, and a copy of this report was provided to the Licensee.