Pre-licensing visit·June 19, 2025

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA met with Applicant Violeta Amurao and toured the facility. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to Community Care Licensing (CCL) on March 10, 2025. The facility is to have a capacity of six residents, (0) ambulatory, (5) non-ambulatory and (1) bedridden residents. Applicant requested a Hospice Waiver for (5). Facility phone number is (714) 884-3046. LPA observed the following. Structure: The facility is a one-story house with four resident bedrooms, one staff bedroom, three full size bathrooms, a living room, a kitchen, a dining room, and a garage. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall by the staff office. There are two gates, each located on the front of the house. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard. Air/Heating: Central air/heating system installed with a central panel to control entire house. Resident Bedrooms: There are four resident bedrooms. All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. CONTINUED ON LIC809-C... Bathrooms: All bathrooms are clean and have working plumbing. Hot water measured between 112.1-113.5 degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen for each resident was stored in the closet by the residents' bedroom hallway. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menu was available. Food Service: There are no residents living in the facility at this time. There is 7-day non-perishable food supply on hand. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors are hardwired and tested operational. Fire extinguishers were charged, mounted and one was located by the entryway and one by the kitchen. Appliances: There is one gas stove, one oven, microwave, a refrigerator, washer and dryer. All appliances are clean and operational. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored in locked cabinet in the laundry room. Water Temperature: Hot water was measured in all bathrooms. Hot water measured between 112.1-113.5 degrees Fahrenheit. CONTINUED ON LIC809-C... Medications, First-Aid Kit & Book: The first aid kit and the first aid manual are stored in a cabinet in the staff's office. The first aid kit has all the required elements. Medications will be stored in locked cabinet in the staff's office. Resident & Staff Files : The resident and staff records will be kept in a locked cabinet in the staff's office. Reading Material, Games, Equipment & Materials: The activities plan include magazines, gardening, books, boards games and exercise activities. Fire clearance: Fire Clearance approved by a fire inspector of Orange County Fire Authority on April 9, 2025. Special conditions noted, "Bedroom 1, 2, and 3 are approved for nonambulatory clients. Bedroom 4 is approved for 1 bedridden client." Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements. LPA advised Applicant to use the general email address: CCLASCPOrangeCountyRO@dss.ca.gov for inquiries and to submit incident reports. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB (Central Applications Bureau) in Sacramento for final review prior to license being issued. Applicant was informed today that the final approval will be processed by CAB in Sacramento. Exit interview was conducted and a copy of this report was left with the applicant.