Pre-licensing visit·July 21, 2025

Licensing Program Analyst (LPA) Celine Rodriguez conducted an announced pre-licensing visit and was greeted and granted entry by Facility Administrators (AD) - Veronica Cuevas and House Manager (HM) - Savvas Kudsi. LPA Rodriguez observed the Administrator's Certificate for Veronica Cuevas 1/17/2027. For this visit, there are 0 residents in care. LPA Rodriguez toured the facility with AD- Cuevas and HM- Savvas Kudsi. Structure: Facility is a single level structure. On 5/1/2025, The Orange County Fire Authority granted a fire clearance for a capacity of 6 residents (which 6 may be non-ambulatory, 2 may be on hospice and 0 may be bedridden). There are a total of 6 bedrooms, which all are private resident rooms, and 1 room designated as a gym for resident use. There are a total of 3 bathrooms of which 2 are full bathrooms and 1 half bathroom. There is is a garage that is utilized as a storage space. Bedrooms: All 6 bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept hazard free. Bathrooms: The restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured at 115.3 degrees Fahrenheit. Linens and Hygiene Supplies: Adequate supply of linens is stored in the bedrooms and in the garage. Posters, Emergency Phone Numbers, Exit Plan: The PUB475 "See Something, Say Something" and Long Term Care Ombudsman poster was posted at the entrance of the facility. Emergency disaster plan is posted at the entrance and is also located in the facility binder. Food Service and Menu: Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to the residents in care and located in a kitchen drawer. Facility had back-up emergency food and water supply located in the garage and in the kitchen. Smoke and Carbon Monoxide Detectors: Smoke and carbon monoxide detectors were tested and operational. Alarms: There are auditory alarms located on each door and pool gate were all were tested and operational. Fire Extinguisher: Fully charged, mounted, and located in the kitchen and in the hallways. Fire extinguishers were dated for 2025. Appliances: Stove is a four-burner induction stove, and there is single oven, dishwasher, refrigerator and freezer. Washer and dryer are located in the garage. Toxins: Inaccessible to residents and located in a locked cabinet in the garage. Medications, PPE First-Aid Kit and Manual: LPA Rodriguez observed that First Aid Kit had all the required components. Medications were locked in a cabinet located in the hallway. Facility had an adequate supply of PPE located in the garage. Backyard: LPA Rodriguez observed that there are 2 exit gates in the backyard on one side, of which are self-closing and self-latching. LPA Rodriguez observed that there is a pool located in the backyard, however is closed off by a 6ft fence, along with an auditory alarm that was observed to be operational. Resident and Staff Files: Records were kept in a locked cabinet located in the hallway. Recreational Activities: The facility has activities that commensurate with plan of operation. LPA Rodriguez reviewed the Component III with AD - Veronica Cuevas and HM - Savvas Kudsi. Per interviews, AD - Veronica Cuevas and HM - Savvas Kudsi stated that they are not planning to advertise for special dementia program for this facility as of this time. Prelicensing visit and Component III are now complete. LPA Rodriguez will provide copy of this report to Centralized Applications Bureau for review and final determination of the application. LPA Rodriguez conducted an exit interview with AD - Veronica Cuevas and HM - Savvas Kudsi and a copy of this report was provided to the facility.