Pre-licensing visit·July 3, 2025

Licensing Program Analyst (LPA) Sommer Hayes conducted an announced Pre-licensing visit to this facility on 07/03/25 and was met by the Applicant, Ana Espinoza. A brief interview was conducted with the Applicant. This facility will be licensed as a Residential Care Facility for the Elderly (RCFE) to serve up to 6 non-ambulatory clients. There were 5 residents present during today's pre-licensing visit. LPA observed one resident watching television in the common room, one resident in the kitchen playing games and three other residents in their bedrooms. LPA conducted an inspection of the facility including but not limited to the 5 resident bedrooms (4 single rooms and 1 double room) and two bathrooms, all of which contained the required furniture, furnishings, and lighting to be in compliance at the present time. All bedrooms had doors with locks to provide clients with privacy. Both bathrooms contained paper towels, soap, grip bars and slip mats. Hot water temperatures were taken and measured at 111. F which is within the allowed range of 105-120 degrees. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels and linens able to meet the needs of the residents. LPA inspected the kitchen, and all knives and sharps were in a locked drawer and inaccessible to residents. LPA observed enough plates, cutlery, pots, pans, and cups for residents. Food supply for 2-day perishable and 7-day nonperishable quantities were reviewed to make sure that this facility was in compliance at this time. LPA observed the locked cabinet where medications for residents are stored so that they remain inaccessible to residents in care. There were a total of 1 fire extinguisher in the kitchen. It was inspected by Jorgensen on 04/02/25. Smoke detectors/carbon monoxide were tested by caregiver and LPA observed they were working. The living room, dining room, and laundry room were also inspected. This facility had no bodies of water present on its grounds. A review of the facility perimeter fence, side gates, and walkways were observed. LPA provided the following advisories to the Applicant: Repair of a window screen in bedroom #2. Advisory was provided to clear out potential hazards on the left side of the storage in the back yard. Component III completed with applicant during visit. Exit Interview conducted with Ana Espinoza copy of this report was left with the Applicant. Per California Code of Regulations (CCR) - Title 22, no deficiencies were observed. An exit interview was held, and a copy of the report was provided. LPA will notify the Central Application Bureau that the Pre-Licensing has been completed and passed.