Follow-up·July 27, 2021

Licensing Program Analyst (LPA) Daniel Pena visited the facility to conduct a Pre-Licensing inspection. LPA identified themselves to Administrator, Jesusa Pascua, and was allowed entry into the facility. LPA met with Ms. Pascua and discussed the purpose of the visit. The Applicant is applying for a change of capacity to serve four (4) developmentally disabled residents, ages 60 and above, two (2) of which may be non-ambulatory. LPA, accompanied by Ms. Pascua, toured the physical plant. LPA observed resident accommodations including furnishings, linens and personal hygiene items. The temperature of the hot water for use by residents was within Title 22 Regulations. Administrative, resident, and staff records were stored in a locked cabinet. Food service including dishes, utensils, food storage and a two (2) day supply of perishable and seven (7) day supply of non-perishable food items were present. Toxic substances are stored in a locked office. Centrally stored medication and administration logs were located in a locked medication room. A first aid kit was located in the locked closet. Activities supplies and sufficient space to conduct are present. Fire extinguishers are affixed with a current tag. Smoke and carbon monoxide detectors are present and operable. Facility posting requirements are present in a common area and the facility administrator's certification is current through 6/2/22 There are no pools or bodies of water. Per Ms. Pascua, there are no weapons or ammunition located on the property. The Component III portion of the application process was completed with the Administrator. This application will be routed to management for approval and the Applicant will be notified by phone and the new license will be mailed to the Applicant. An exit interview was conducted with the Administrator, and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.