Pre-licensing visit·July 2, 2025

On 7/2/2025 at 9:00 AM, Licensing Program Analyst (LPA) Shakaricka Hughes and Pang Lee arrived announced to conduct a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA Hughes met with Administrator Veniana Banuve. Licensee assisted LPA Hughes in today’s inspection. This Applicant is seeking licensure for a (6) non ambulatory Residential Care Facility for the Elderly (RCFE) to accept and retain at any given time. The facility will have 2 staff, 1 of which will be a live-in care staff. There are 5 residents at this time. Veniana Banuve will be the Administrator of this facility. The facility administrator’s certificate # 7030527740 and will expire 04/19/2027. The facility has an infection control plan and an emergency disaster plan completed and provided to Licensing for approval. The facility fire clearance has been approved as of 6/24/2025. LPA Hughes toured the facility, Residents’ bedrooms were observed, and furniture and furnishings were observed to be sufficient and able to meet the needs of the residents. LPA Hughes inspected the kitchen area. Cabinets and drawers were opened and reviewed at this time.  Silverware, plates, and utensils were observed to be sufficient to meet the needs of the residents at this time.  Knives, cleaning agents, and bleach were observed to be locked and made inaccessible to the residents at this time. Continuation 809-C The food storage unit, facility refrigerator, was observed to be functional and in good repair at this time. Food supplies were reviewed for adequate 2-day perishables and 7-day non-perishable quantities, and they both were observed sufficient at this time. The living room and dining area were observed to be furnished and sufficient to meet the needs of the residents at this time. LPA Hughes observed a telephone made available to residents in the kitchen. The facility smoke detectors, carbon detectors and fire extinguisher were observed to be in good condition. The fire extinguisher was last serviced on 08/20/2024. Linen closet was observed with a sufficient supply of sheets, bedding, pillowcases, and blankets to meet the needs of the residents at this time. The water temperature measured at 121.4 degrees Fahrenheit, and the facility temperature measured at 73 degrees. LPA Hughes observed the centrally stored medication areas to be locked. LPA Hughes inspected the first aid kit, and it was complete with all required components. Emergency flashlights, and batteries were observed sufficient at this time. Resident records, staff records, were observed in a hallway closet locked and inaccessible to residents in care. LPA reviewed 5 out of 5 resident files and they were complete. LPA reviewed 2 staff files, and it was complete. LPA reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared LPA Hughes, toured the outside of the facility, and observed outside area enclosed by a fence, stairways, inclines, and outdoor passageways, and self latching side gate was observed free of obstruction, and accessible to residents in care. Outside activity area is equipped for activity outdoor use. LPA toured the garage area, and observed resident hygiene items, cleaning chemicals, toxins, and other supplies located above the washer and dryer. Washer, Dryer and water heater was observed to be in good repair at this time. LPA Hughes discussed and recommended the Technical Support Program (TSP) to the applicant. Veniana, the applicant expressed interest in being recommended to the program. LPA Hughes advised the applicant that a referral to TSP will be completed. Based on a review of this facility during this Pre-licensing visit, it was determined that this facility was found to be in compliance at this time.  The applicant has passed the pre-licensing component III of the application process. LPA Hughes will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. An exit interview was conducted, and a copy of this report has been provided to the facility.