Pre-licensing visit·August 5, 2021

Licensing Program Analyst (LPA) Adam Hamer conducted an announced Pre-Licensing and Component III visit at the facility on today's date to inspect the facility for compliance with Title 22, Division 6, Chapter 8 of the California Code of Regulations and the Health & Safety Code. This is an initial application for licensure; the facility has no residents in care. LPA identified himself at the door and was granted entry by Applicant Rolando Corpuz. LPA and Applicant toured the physical plant, inside and out, and LPA observed the following: Resident accommodations were in compliance with regulations, including furnishings, linens, and personal hygiene items; resident bathrooms were equipped with grab bars, non-skid mats, and water temperature measured at 106.8 degrees Fahrenheit in a bathroom to be used by residents; the facility’s ambient room temperature was 72 degrees Fahrenheit at the time of the visit; there was a cabinet with locked doors for medications and for staff and resident records; food service, including dishes, utensils, food storage, and a seven day supply of non-perishables and a two day supply of perishables were present, and knives and sharp objects were locked in a cabinet in the kitchen; toxic substances were stored in a locked cabinet; first aid kits and first aid manuals and proper supplies were stored in a facility closet; activities, supplies and sufficient space in which to conduct activities were present; fire extinguishers, smoke and carbon monoxide detectors were also present and operable; required facility postings were present and visible in a common area of the facility. According to Applicant, there are no guns, weapons, or ammunition stored on the facility property. A swimming pool was observed on the facility property with locked gates outside the perimeter and in compliance with regulations. The administrator's certificate expire on August 12, 2022. (continued on 809C) LPA also conducted and completed the Component III with Applicant during the visit. LPA verified that Applicant’s understanding of Title 22 continuing requirements, including physical environment, reporting requirements, personnel and resident records, incidental medical care, health related services and activities. All items reviewed during the visit are in compliance with Title 22, Division 6, Chapter 8 of the California Code of Regulations and the Health and Safety Code. Applicant was advised that the application is pending management final review and approval. An exit interview was conducted with Applicant and a copy of this report and Applicant Rights (LIC 9058) were provided to Applicant via electronic mail; Applicant expressed to LPA that he would send an email confirmation upon receipt of these documents.