Pre-licensing visit·December 3, 2021

Licensing Program Manager (LPM) Denise Powell and Licensing Program Analyst (LPA) Esther Miller conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6, Chapter 8 of California Code of Regulations and Health & Safety Code. LPA and LPM were met and granted entry by Gaurav Rathi, Applicant. The facility fire clearance was granted on November 10, 2021 and reflects that the facility is approved for five (6) non-ambulatory residents, one(1) of whom may be bedridden. This is a change of ownership application. During today's visit, LPA, accompanied by Gaurav Rathi and Nikita Mundhada, toured the facility inside and outside and inspected every room. The facility was found to be in good repair with no pathway obstructions. Residents' bedrooms were observed to be clean and ready for occupancy. Toilets were found to be in working order. Facility temperature was 72 degrees F during the visit. Water temperature in bathroom measured at 116.4 degrees F. LPA observed locked cabinets and closets in which hazardous and/or toxic chemicals will be stored and secured. There is a locked cabinet for storage of medications and client records. Staff records are maintained online on a cloud. There is also a complete first aid kit present in the facility. Activities and sufficient space in which to conduct activities are present. Smoke and carbon monoxide detectors are hard-wired, were recently inspected by the local fire authority, and found to be in working order. No pools or bodies of water were observed near or on the premises. According to the applicant, no firearms and/or ammunition are present or will be stored in the facility. Ample and appropriate storage was present to store perishable and non-perishable food items. Non-perishable food items were present for future resident use. Required postings were observed in a visible area of the facility. Items reviewed during today's visit are in compliance with Title 22, Division 6, Chapter 8 of California Code of Regulations, and applicant has passed the pre-licensing inspection. Component III was completed during today’s visit. Gaurav Rathi was advised that the application is pending management final review and approval. This report was discussed with the applicant, and a copy of the report and Applicant Rights (LIC9058) were provided to the applicant via email following the conclusion of the visit.