Pre-licensing visit·September 26, 2023

Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced on 9/26/2023 to conduct a pre-licensing inspection. Upon arrival. LPA met with Applicant Elaine Tolentino and explained the purpose of the visit. Applicant holds current administrator certification #6063633740 and expires on 8/14/2024. This Applicant was seeking licensure for a 6-bed RCFE non ambulatory with an approved hospice waiver for (6) residents at any given time. A bedridden fire clearance was also granted for (1) resident at any given time in designated bedroom #2. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms; resident bathrooms, laundry area, and garage to ensure compliance with Title 22 regulations. A review of the facility perimeter fence, side gates, and all other exits were conducted. LPA observed the facility is clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. The hot water temperature was observed to be 107.1 degrees Fahrenheit. The temperature inside the facility measured at 75*F which is within the required range of 68-85*F. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed knives and toxins to be locked away and inaccessible to clients. LPA observed the centrally stored medications area to be locked and inaccessible to clients. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. Continued on 809-C The following forms and documents were requested to be updated and submitted into CCL at this time: LIC 308 LIC 400 LIC 500 Based on today's Prelicensing visit this facility has been found to be in compliance at this time. Component III conducted and completed with facility Applicant at this time. LPA will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. Final approval of the license by the Applications Analyst is pending. Exit Interview