Pre-licensing visit·October 13, 2022

Licensing Program Analyst (LPA) Michael Hood met with applicant, Karl Ramos, to conduct a Pre- Licensing visit. This application is a change in ownership. This address is currently licensed as NORTH AVENUE VILLA Facility #: 347003843. The facility has a fire clearance for six (6) bedridden residents. Applicant holds a current administrator certificate (#6063204740 with expiration date 7/26/2024). LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and four (4) bathrooms for resident use. LPA observed facility to be properly furnished, including appropriate bedding and lighting in bedrooms. Bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 115 degrees F. LPA checked the kitchen area for the ability to prepare and store food. LPA observed at least a 2-day perishable and 7-day nonperishable food supply at the facility. LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detectors at the care home are operational. LPA reviewed two (2) resident files and two (2) staff files. LPA observed during visit that one (1) fire extinguisher needs to be serviced, and files for residents were missing items. LPA indicated all the above observations need to be fixed and facility will send corrections to CCLD within 7 days from today's date. Component III was waived. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) for final review and approval once requested items have been received. CAB will further contact applicant on final status of application. A copy of this report was provided to the facility. Exit interview conducted.