Pre-licensing visit·July 6, 2021

Licensing Program Analyst (LPA) Dawn Segura conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6, Chapter 8 of California Code of Regulations and Health & Safety Code. LPA was met and granted entry by Terry Wery, Applicant. The facility fire clearance was granted on June 16, 2021 and reflects that the facility is approved for fifteen (15) non-ambulatory residents, thirteen (13) of whom may be bedridden. During today's visit, LPA, accompanied by Terry Wery and Everett Wery, toured the facility inside and outside and inspected every room. The facility was found to be in good repair with no pathway obstructions. Residents' bedrooms were observed to be clean and ready for occupancy. Toilets were found to be in working order. Facility temperature was 75 degrees F during the visit. Water temperature in two resident bathrooms measured at 110 degrees F. LPA observed locked cabinets and closets in which hazardous and/or toxic chemicals will be stored and secured. There is a locked room for storage of medications and client and staff records. There is also a large first aid kit present in the facility. Activities and sufficient space in which to conduct activities are present. New fire extinguishers were observed in the facility. Smoke and carbon monoxide detectors are hard-wired, were recently inspected by the local fire authority, and found to be in working order. No pools or bodies of water were observed near or on the premises. According to the applicant, no firearms and/or ammunition are present or will be stored in the facility. Ample and appropriate storage was present to store perishable and non-perishable food items. Non-perishable food items were present for future resident use. Required postings were observed in a visible area of the facility. Items reviewed during today's visit are in compliance with Title 22, Division 6, Chapter 8 of California Code of Regulations, and applicant has passed the pre-licensing inspection. Component III was completed during today’s visit. Terry Wery was advised that the application is pending management final review and approval. This report was discussed with the applicant, and a copy of the report and Applicant Rights (LIC 9058) were provided to the applicant via email following the conclusion of the visit.