Pre-licensing visit·February 10, 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 himself to, and explained the purpose of the visit to applicant Kelly Flora and staff Kevin Posada. The facility fire clearance was granted on November 8, 2021, and reflects that the facility is approved for six (6) residents, all of whom may be non-ambulatory. During today’s visit, LPA, accompanied by the applicant, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. 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 76 degrees F. Water temperatures were complaint at all taps: kitchen was 113.5 F, while bathrooms were 114.6 F, 111.4 F, and 114.6 F, respectively. The facility has enough linens, hygiene supplies, dining supplies, and perishable and non-perishable food for resident use. Refrigerator temperature was 38 F, and freezer temperature was 0 F. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of medication and confidential resident and staff records. 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 detector, emergency lighting, and facility telephone were all operational. One fire extinguisher and one complete first aid kit were present. Required licensing postings were observed in visible areas of the facility. The items reviewed were complaint with Title 22, Division 6, Chapter 8 of California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection. LPA also provided the Component III Training during today’s visit. The applicant was advised that the facility’s application is pending management final review and approval. An exit interview was conducted with Flora and Posada. A copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided to the applicant via E-mail.