Pre-licensing visit·October 18, 2024

On 10/18/24 Licensing Program Analyst (LPA) Arvin Villanueva arrived announced to conduct a pre-licensing inspection. LPA Villanueva met with Administrator Eric Serrano and Licensee Laila Dungca, and explained the purpose of the visit. The facility is currently undergoing a Change of Ownership. LPA observed 1 residents in care. LPA learned the residents are scheduled to move out by the end of the month. Eric Serrano will be the designated Administrator. Administrator Certificate # 7023144740, expires on 08/26/26. The facility has an approved fire clearance for six (6) non-ambulatory residents for bedrooms #1, #2, and #3. There is a separate sleeping area designated for staff only located at the second floor of the house. The facility has a granted hospice waiver for three (3). Dementia plan has been submitted. LPA Villanueva reviewed the infection control plan and their emergency disaster plan. Licensee and Administrator has identified the location of their shut off valves. Note this facility does not have shut off valve for gas as it is equipped with solar panel. LPA observed the physical plant to ensure compliance with Title 22. LPA observed the common areas to be cleaned, organized, and free from debris. Areas were observed to be fully furnished. LPA observed resident bedrooms to be equipped with beds, clean linens, a dresser, night stand, closet space, a chair, and a lamp. Resident bathrooms were stocked with hygiene supplies, hand soap, paper towels, a lidded trash can, a non-skid mat, shower chair, non-skid flooring and hand rails. Bathrooms were observed to be clean. Each bedroom is equipped with smoke detectors. Smoke detectors were also observed in the hallway and living room. Carbon monoxide was observed in the resident hallway. They were tested and found operable during this visit. LPA observed second floor (staff room) to have smoke detector. The backyard was observed to have a covered patio area for outdoor activities and equipped with outdoor furniture. Storage shed were observed to be locked. Fence and gates were observed to be in good repair at this time. Emergency exits were clear of obstructions. Medications, sharps, chemicals, and cleaning supplies were observed to be locked and inaccessible to residents in care. LPA observed the files are maintained and available for review. LPA conducted Component III with Licensee Laila Dungca and Administrator Eric Serrano. There were no further questions from either the Licensee or Administrator. The applicant has passed the pre-licensing component of the application process. LPA will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. An exit interview was held, and a copy of the report was provided.