Pre-licensing visit·January 11, 2022

Licensing Program Analyst(s) (LPA) Victoria Brown and Jamie Ivey Canady arrived announced to conduct a Pre-licensing visit on 1/11/22 at 9:30AM. The Administrator certificate expires 5/3/2022 for Jennylind Duran. LPAs met with Jennylind Duran, Administrator on behalf of the Applicant and stated the purpose of todays visit. The facility will be licensed for a capacity of 6 non-ambulatory residents of which 1 may be bedridden. Hospice Waiver approved for 6 to receive hospice care services. LPAs toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents in care. LPAs observed rooms to have required furniture. LPAs observed residents during this visit. LPAs observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days which shall be maintained on the premises. The temperature inside the facility was observed to be at 70*F which is within the required range of 68-85*F. The hot water temperature was measured at 109.5*F which is within the required range of 105-120*F. LPAs observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air, and pull alarm system in the facility. LPAs observed the centrally stored medications area to be locked and inaccessible to residents. Administrator demonstrated the use of Medication Administration Record (MAR) and a review of resident #1 (R1) medication's was conducted. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. Component III conducted-Licensure pending. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, copy of report given