Pre-licensing visit·April 25, 2025

On 4/25/25, at 830, Licensing Program Analyst(LPA) Noel Wolf Petersen and Licensing Program Manager(LPM) Liza King, arrived announced to do a prelicensing inspection. They were met by administrator Lit Tien and staff Chris Sinon, and explained the purpose of the visit. The Physical Plant was inspected, including but not limited to the recreation areas, living room, storage, hallways, client bedrooms, client bathrooms, and kitchen. The facility was found to be in physical compliance with the required furnishings and cleanliness. No bodies of water were observed. The first aid kit was inspected and found to have the required items, the fire extinguishers was stored properly and checked on 11/21/24 and found in compliance. The bathrooms had the resident temperature at 117.3*F, between the required 105-120. The trash cans were clean and secured, the food storage had 2 days of perishables, and 7 days of non-perishable food as per regulation. Sharps and toxics were stored in locked containers, medication storage was ready and available. In a subsequent prelicensing inspection the LPA is recommending that the the following are available for inspection/review: surety bond, that have bedbug casing for the mattresses, storage in the garage is clear of sharps and toxics, that the sample staff and client records are available, that the admission agreement, infection control plan, and plan of operation are ready to review, that they have and emergency kit with items and sample documentation ready to go, posters should be of correct dimension, updated LIC 308 and 500, notification for audio visual surveillance on the front door, all personal belongs removed from the facility, and fresh fruit and vegetables available for clients. Continued on c page The facility is ready to be licensed, however prior to accepting any clients into care a reinspection must occur. The assigned anaylst is Pang Lee 916-508-9726. The facility is pending vendorization to provide services to elderly 4I individuals. During this time, the licensee agreed to the following: they will maintain their fees with licensing they will notify community care licensing before a client arrives they will maintain control of the property a mandatory reinspection will occur before accepting residents they will maintain contact information by phone and email. An exit interview was conducted and the report read and delivered to the staff. COMP III was not conducted on this date, the licensee is an already existing licensee with a home operating in the Regional Office and in compliance.