Pre-licensing visit·May 19, 2021

Licensing Program Analyst (LPA) Tiffany Holmes conducted a Pre-Licensing Virtual Visit, LPA was greeted at the front door by Zayden Chen, Owner. LPA was granted entry after identifying herself and disclosing the purpose of their visit. The LPA and owner toured the physical plant, and LPA observed the following: resident accommodations, including furnishings, linens, and personal hygiene items; resident bathrooms were equipped with non-skid mats, and water temperature measured at 108.8 degrees Fahrenheit in bathroom designated for use by residents; resident and staff records will be located in a locked cabinet in the administrators office; food service, including dishes, utensils, refrigerators, freezers, and adequate food storage and preparation space are present; cleaning and potentially toxic substances are stored in a locked cabinet in the laundry room; the storage of medications are in a med cart in the administrators office also; first aid kit is stored in a locked closet; sufficient space in which to conduct activities is present; a fire extinguisher is present and mounted in the facility kitchen; smoke and carbon monoxide detectors are present, and determined to be operable; required facility postings are present and visible in a common area of the facility. According to the administrator, there are and will be no guns, weapons, or ammunition stored on the facility property. No swimming pool on site and there is an open body of water that was observed on the facility property with a Koi pond that is gated and far away from the facility building. The administrator’s certification for Ma Teresa Derafera, Administrator expires on 11/13/2022. Component III was conducted and completed following the pre-licensing physical inspection. Items reviewed during the visit are in compliance with Title 22, Division 6, Chapter 8, of California Code of Regulations. The licensee was advised that the application is pending management final review and approval. A copy of this report and Applicant Rights (LIC 9058) were provided to Zayden Chen, Owner.