Pre-licensing visit·June 2, 2022

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an announced Pre-Licensing visit. LPA was met by Applicant Tonya Weaver and was granted entry into the facility. The purpose of today's visit is to inspect the facility to ensure that it is in compliance with California Code of Regulations, Title 22, Division 6. The fire inspection was completed on 5/16/2022 and the facility is approved for 5 non-ambulatory residents and 1 bedridden resident. The facility has an approved hospice waiver for 6 residents. During today's visit, LPA toured the facility and inspected every room. The facility was found to be clean and in good repair with no pathway obstructions. Client bathrooms were observed to be clean and the toilets and showers were found to be in working order. The facility's water temperature in the 2 resident bathrooms were measured at 109.0 degrees Fahrenheit and 115.0 degrees Fahrenheit respectively, and the visitor bathroom was measured at 116.4 degrees Fahrenheit. LPA observed locked storage areas where all hazardous and/or toxic chemicals were stored and secured. LPA observed locked storage for clients' medications. A functioning carbon monoxide detector and smoke detectors were observed in the facility. No bodies of water were observed near or on the premises. LPA observed 7-day supply of non-perishable food. Required postings were observed in a common area and hallways of the facility. According to the applicant, no firearms will be stored at the facility. LPA conducted Component III with the applicant. The topics discussed were continuing operation requirements, record keeping/reporting, and physical plant compliance. Pre-licensing is complete and it is recommended that this facility be licensed pending final review and approval. An exit interview was conducted with the applicant and a copy of this report was provided via hard copy. This is an amended version of the original report created on June 2, 2022.