Pre-licensing visit·September 20, 2021

Licensing Program Analyst (LPA), Debbie Correia, conducted an announced Pre-licensing and Component IIl visit at a Residential Care Facility for the Elderly (RCFE) to ensure compliance with California Code of Regulations, Title 22, Division 6 and the Health and Safety Code. LPA Correia identified herself to Applicant Kay Cabuco and Administrator Anna Kearns and explained the purpose of the visit. The application is to serve fifteen (15) residents ages 60 and above, all (15) of whom must be non-ambulatory and/or receiving Hospice Care. The facility can also serve five (5) bedridden residents . The Lakeside Fire Protection District granted Fire Clearance on July 21, 2021. During today's visit LPA Correia, accompanied by Applicant Cabuco and Administrator Kearns conducted a tour of the facility. According to Applicant Cabuco, there will be no firearms or ammunition stored on site. No pools or bodies of water were observed. Indoor and outdoor passageways are free from obstructions. All window screens are clean and in good repair. All facility hallways are well-lit. fire, smoke alarms, and carbon monoxide detectors were all observed and operational. There is a bed for each resident's bedroom, equipped with padded covered mattresses, and pillows, observed clean and in good repair. There is sufficient closet and drawer space for resident belongings. Each resident bedroom is furnished with a chair, lamp, and a night stand. Resident bathrooms are also in good repair, equipped with handrails, and non-skid mats. The facility maintains a sufficient supply of clean linens, sheets, bedspreads, blankets, pillowcases, mattress covers, hand towels, and washcloths. LPA Correia observed a seven-day supply of non-perishable and a 3 day supply of perishable food. A sample of the facility meal menu was present. The facility kitchen also maintains sufficient amounts of clean utensils, and equipment for proper storage of food items, and locked storage for sharp items (i.e. knives). LPA Correia observed an office for administrative staff that has a confidential storage area for personnel and resident records. LPA observed a locked storage cabinet for residents' medications. Emergency exit plans, facility policy, and residents' personal rights are posted in prominent areas. There is a shaded outdoor activity space, and a common room available for visitors. LPA observed a first aid manual and kit maintained at the facility. The facility area to store cleaning supplies and other toxic chemicals. There is an operating telephone land line. There is emergency lighting and supplies readily available for safety measures. The hot water temperature used by residents in care measured between 116 and 118 degrees F, and the central air unit measured 76 degrees. Component III was completed with the facility applicant and Administrator. LPA Correia reviewed continuing operational requirements, as well as record keeping and physical plant compliance. The applicant shall contact the Centralized Application Bureau (CAB) for completion of this pending facility application. Based on today's evaluation, the facility is in compliance with CCR, T22 and the Health and Safety Code. Final approval is forwarded to management pending review. Pre-licensing inspection is complete and the facility has no deficiencies. An exit interview was conducted, and a copy of this report, and Licensee's Rights (9058 01/16) will be sent to the Administrator's e-mail address. An electronic mail read receipt confirms delivery of these documents.