Pre-licensing visit·September 3, 2021

Licensing Program Analyst (LPA) Carmen Lopez conducted an announced Pre-Licensing and Component III inspection at a Residential Care Facility for the Elderly for a change of ownership 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. After arriving at the facility, LPA identified herself, disclosed the purpose of the visit and was granted entry by the Kristine M. Skoglin, Licensee. LPA toured the physical plant, inside and out, and observed the following: Resident accommodations were in compliance with regulations, including furnishings, linens, and personal hygiene items; resident bathrooms were equipped with non-skid flooring, and water temperatures measured at: kitchen faucet #1 117.1 degrees Fahrenheit (F), faucet #2 at 111.8 degrees F, bathroom in bedroom #1 112.6 degrees F, hallway bathroom at 109.4 degrees F, bathroom in bedroom #2 113.8 degrees F, bathroom in bedroom #3 109.8 degrees F, bathroom in bedroom #4 108.0 degrees F, bathroom in bedroom #5 115.9, bathroom in bedroom #6 112.5 degrees F, laundry room at 112.3 degrees F; the facility’s ambient room temperature was 75 degrees F at the time of the visit; medications will be stored in a locked cabinet in the back. Staff records were kept in a secured area in the business office; Resident records were kept in a locked cabinet in the back area. Food service was within the requirements of regulations, including dishes, utensils, food storage, and a seven (7) day supply of non-perishables; the two (2) day supply of perishables will be bought once clients are admitted. Knives and sharp objects were inaccessible to residents in care; toxic substances were stored in a locked cabinet; first aid kits and required supplies were stored in a the back area; the first aid manual was purchased and will be at the facility prior to resident’s acceptance. Activity supplies and sufficient space in which to conduct activities were present; fire extinguishers were present throughout the facility; smoke and carbon monoxide detectors were present and operable; required facility postings were present and visible in the common area of the facility. According to the Licensee, there are no guns, weapons, or ammunition stored on the facility property. The facility does not have a swimming pool or bodies of water. LPA conducted and completed the Component III with the Licensee Kristine M. Skoglin during the visit. LPA verified her understanding of Title 22 continuing requirements, including physical environment, reporting requirements, personnel and resident records, incidental medical care, health related services and activities. No deficiencies were observed during today's visit as 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. The Licensee was advised that the application is pending management final review and approval. An exit interview was conducted with her and a copy of this report and Applicant Rights (LIC 9058) were provided to her via electronic mail; she expressed to LPA that she would send an email confirmation upon receipt of these documents.