Pre-licensing visit·June 2, 2021

Licensing Program Manager (LPM), Alexandre Vo, conducted an announced Pre-Licensing/Component III. LPM identified himself to Executive Director, Sasha Hightower, and explained the purpose of the visit which was to evaluate Title 22 compliance for change of ownership. The facility plans to serve elderly residents, ages 60 and over. The Fire Clearance was granted on February 16, 2021. Facility is approved for 125 non-ambulatory residents of which 15 may be bedridden. Hospice Waiver for 17. The Fire-Clearance is also approved for delayed egress. An inspection of the facility was conducted inside and out. A sample of eight resident rooms were observed. Bathrooms are equipped with toilets, hand washing and bathing facilities which are sanitary and in operating condition. Water temperatures ranged from 106 degrees to 113 degrees F for the resident and common area bathrooms. All lighting fixtures and facility windows were operable and in good condition. A night-light was present in the hallway leading to the restroom. Outdoor and indoor passageways were free from obstructions. Fire extinguishers were affixed with current tags. Smoke and carbon monoxide detectors were present and operational. There were no pools or other bodies of water observed on the premises. Locked cabinets and storage areas were identified to store toxic substances, knives, and medication. Hazardous items were stored such that they were inaccessible to residents. Per Executive Director, no weapons or ammunition are or will be stored at the facility. LPM observed facility accommodations including food supplies, medication storage, first aid kit as well as toiletries and linens. Required CCLD postings were present. LPA discussed the RCFE Comp III with Executive Director Hightower for continuing operational requirements, record keeping, reporting requirements and physical plant compliance. Executive Director's Administrator Certification is current through January 20, 2022. Technical assistance was provided in the areas observed and listed on the Advisory Notes. The Executive Director was advised that the report is pending management approval. An exit interview was conducted with Executive Director. A copy of this report along with the licensee Appeal Rights (LIC 9058 01/16) will be provided via email. An electronic email read receipt confirms the documents were received.