Pre-licensing visit·July 10, 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/ Licensee (AD) Imelda Nuval Lenz. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by our agency on May 6, 2025 for a total capacity of six; five non ambulatory and one bedridden in bedroom #4. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms . The hot water temperature measured between 119.5 and 120.0 degrees Fahrenheit and all smoke and carbon monoxide detectors were operational . The three fire extinguishers were charged and purchased on May 1, 2025. The facility has an Emergency Disaster and Infection Control Plan. LPA inspected the kitchen and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand . Sharps/knives and cleaning supplies were locked underneath the sink. Emergency water was stored in the garage. All appliances, refrigerator/freezer, dishwasher, washer/dryer and stove are new and in working order. LPA observed the locked medication storage and First Aid Kit. The First Aid Kit had all of the required elements. The PUB 475 "See Something, Say Something" poster was posted in the main entryway; as well as the Long Term Care Ombudsman poster. Emergency Disaster Plan, Theft and Loss, Resident/Family Rights and Grievance Procedures were posted. AD will post visiting hours as well. (Continued on LIC 809-C) (Continued from LIC 809) LPA toured each of the four bedrooms and all had the required furnishings and linens. A fire door separates the common living/dining areas from the bedrooms. Three bedrooms are shared with bedroom #4 allowed for a bedridden resident. The fourth bedroom is a staff room. LPA inspected the exterior and there were no obstacles in pathways. All exterior gates were open and accessible. There is a shaded seating area and plenty of outdoor space for activities. There were board games, pool noodles and word search puzzles in the common living room for activities. Administrator Imelda Nuval Lenz has a current Administrator's Certificate that expires on August 21, 2025. 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.