Pre-licensing visit·February 17, 2022

Licensing Program Analyst (LPA) Dang Nguyen conducted an announced Pre-Licensing visit to observe the facility’s physical plant and records for compliance with Title 22, Division 6, Chapter 8 of California Code of Regulations and Health & Safety Code. LPA was greeted by, identified themselves to, and explained the purpose of the visit to applicant Juman Yacoub. The facility fire clearance was granted on December 16, 2021 and reflects that the facility is approved for six (6) non-ambulatory residents. During today’s visit, LPA, accompanied by the applicant, toured the interior and exterior of the facility and inspected each room. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets and showers were in working order. The facility’s ambient internal temperature was 77 degrees F. Water temperatures were compliant as follows: Kitchen was 115.2 F, Bathroom #1 was 109 F, Bathroom #2 was 110.7 F, Bathroom #3 was 106.2 F, Bathroom #4 was 115.3 F, Bathroom #5 was 107 F, and Bathroom #6 was 119 F. The facility has enough linens, hygiene supplies, dining supplies, and perishable and non-perishable food for future resident use. Refrigerator temperature was 39 F, and freezer temperature was 0 F. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per the applicant, no firearms or ammunition are or will be stored at the facility. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. One fire extinguisher and two first aid kits were present. Required licensing postings were observed in visible areas of the facility. The facility has locked areas for storage of medication and confidential staff and resident records. Staff and resident records contained the required elements. The items reviewed were complaint with Title 22, Division 6, Chapter 8 of California Code of Regulations and Health & Safety Code. The applicant passed the pre-licensing inspection. LPA also provided the Component III Training during today’s visit. Yacoub was advised that the facility’s application is pending management final review and approval. An exit interview was conducted with the applicant, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail.