Pre-licensing visit·August 4, 2021

Licensing Program Analyst (LPA), Kristina Ryan, conducted an announced Pre-Licensing visit to observe the facility's compliance with Title 22, Division 6 regulations and the California Health and Safety code. LPA met with administrator, Richard Edwards. Facility is applying to serve six (6) elderly residents, ages 60 and over, all of whom can be non-ambulatory. During today's visit, LPA observed resident rooms and found them to have proper furnishings, and adequate linens. Sinks accessible to residents had water temperatures measured between 115.7 and 117.1 degrees Fahrenheit. Facility temperature was read at 76 degrees Fahrenheit. Facility had four working fire extinguishers. Smoke and carbon monoxide alarms were demonstrated to be operational. Facility had preparation space for food service and kitchen was observed to have all needed supplies for food service. Space inside the facility is sufficient for activities. Administrator stated that there was no weapons or ammunition on facility property. No bodies of water were observed on the facility property. Staff and resident records were stored in a locked cabinet. There is a shaded outdoor space and appropriate resident activities. All cleaning supplies or potentially hazardous materials were locked in a separate room. Facility has an a locked area for resident medications and a first aid kit. Administrator's Administrator Certificate expires on October 28, 2021. Component III was reviewed with administrator. The application will be sent to the Centralized Application Bureau for final review and approval. An exit interview was conducted with Richard Edwards. A copy of this report and Applicant Rights (LIC 9058 01/16) was provided email. An electronic read receipt confirms receipt of these documents.