Pre-licensing visit·April 4, 2022

Licensing Program Analyst (LPA) Melody Brown conducted an announced visit to the facility 04/04/2022 for the purpose of a Prelicensing Visit. At 9:30 AM, LPA met with Administrator Fritzie Subaan and Applicant Norlina Ruiz . An initial application for license to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 12/08/2021 for a total capacity of four (4). Fire clearance was granted on 12/20/2021 for four (4) non-ambulatory residents. LPAs Brown observed the following: Structure: Facility was a two (2) level house with five bedrooms; two bedrooms in the main floor for residents and three (3) staff bedrooms at the second level., three resident/staff bathrooms, living room, dining area and kitchen. There is an attached two (2) car garage. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control the entire house. Bedrooms: Each resident bedrooms accommodate any non-ambulatory resident. All resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke and carbon monoxide alarm. Bathrooms: The three staff/resident bathrooms have a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap. At 11:30 AM, LPA tested the water temperatures in the resident bathrooms. LPA verified water temperature was measured at 107 degrees Fahrenheit. ***CONTINUED ON LIC 809C*** ***CONTINUED FROM LIC 809*** Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. There is more than seven (7) days supply of perishable foods and more than three (3) days supply of non-perishable foods. There was adequate seating for meals for all residents. Laundry room with washer and dryer was in the main level. Laundry detergents and cleaning supplies are stored in the chemical storage room. Living/Family room: There was a living/family room with adequate seating for all residents and a working TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outside: Patio furniture for outdoor seating observed. Gates on the left side of the facility. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketches were observed posted in the hallway, and two (2) resident bedrooms. No Ombudsman poster but LPA Brown provided Ombudsman phone number for the facility to request an Ombudsman poster. Also, Let-Us-No poster was observed. General items: Two (2) fire extinguishers were charged and located throughout the facility. Dual smoke alarms and carbon monoxide detectors were tested and were observed to be in working order. Resident records will be stored in a locked cabinet. First Aid kit with required components, and locked area for medication storage was observed. LPA observed a facility phone and was operational as evidenced by LPA dialing the number. The phone number designated for the facility is 951-742-5887. There is enough Emergency water supply observed and the required 72-hour emergency food supply was observed from the regular food supply. Component III was completed on this day as well. ***CONTINUED ON LIC 809C*** ***CONTINUED FROM LIC 809C** Additionally, LPA observed facility to have required single entry point for COVID screening, upon entering the facility. LPA observed required COVID signages throughout the facility, Visitation Vaccination Requirement Log and soap and disposable towels in bathrooms for washing hands. LPA observed activities for the residents such as books and games. The facility was evaluated in accordance with the CCR, Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of residents in care. Facility appears to be ready for licensure. An exit interview was conducted, and a copy of this report was reviewed and provided to Administrator Fritzie Subaan and Applicant Norlina Ruiz.