Pre-licensing visit·November 8, 2023

Licensing Program Analyst (LPA) Cheryl Goodrich arrived at 8:43 AM. to conduct an announced Pre-Licensing visit. LPA met the Administrator, Bianca Ivascu at the front door and was granted entry. The purpose of today’s visit is to inspect the facility to ensure that the facility meets the licensing requirements according to California Code of Regulations, Title 22, Division 6. The facility is approved for 6 non-ambulatory residents, 1 may be bedridden, and hospice waiver for 6. Infection Control: The facility has an approved infection control plan and a surplus of supplies for infection control including but not limited to mask, gloves, gowns, first aid kit, and cleaning supplies. Physical Plant and Environmental Safety : The facility temperature read at 69 degrees. The facility consists of 4 resident bedrooms (2 shared bedrooms and 2 private bedrooms) and 2 resident bathrooms, living room, dining room, garage and backyard. The bedrooms are furnished with lighting, closet space, dresser and tv. The beds are clean and have clean linens and the pathways are clean and clear of obstruction. The bathroom temperature read at 105 degrees within regulation requirements. The living room and kitchen are clean and clear of obstruction. The medications will be stored in a locked cabinet in the kitchen and inaccessible to the resident. The facility and has a current fire clearance, smoke and carbon monoxide detectors and fire extinguishers and are in working order. (Continued to LIC809-C) (Continued from LIC809) Personnel Records-Training: There are no staff currently hired at this time. The Administrator’s records are completed with fingerprint clearance, Health screening for TB, CPR/First Aid training, and in-service trainings. Client Records-Incident Reports: The facility has no residents in care and does not have any client reports including but not limited to identification and emergency information, physician’s orders, MAR, and additional assessments. The facility will not handle the resident’s cash resources. Client Rights-Information: The facility has client rights information posted in the facility. Food Service: 7-day non-perishable and 2 day of perishable food supply was observed, and all food was properly stored and available. Health- Related Services: The facility has a medication logbook (MAR), however no records are present due to no residents in care. Disaster Preparedness: The facility has a disaster plan and has posted the evacuation plan, visible for staff and residents in care. The fire drills are completed every 3 months. The facility has emergency supply of food and water. Summary: Based on today's visit, no deficiencies were observed at this time. The Pre-Licensing inspection has been completed. An exit interview was conducted with Administrator, Bianca Ivascu and a copy of this report was printed Signature below confirms receipt of these rights.