Pre-licensing visit·January 18, 2024

Licensing Program Analysts (LPAs) Dang Nguyen and Juliana Barfield conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPAs were greeted by, identified themselves to, and explained the purpose of the visit to the applicant’s representative, Administrator Christine Tapia. The facility fire clearance was granted on 10/05/2023 and reflected that the facility was approved for six (6) residents in total, of which all may be non-ambulatory, but none may be bedridden. The facility's fire clearance did not include endorsements for delayed-egress doors or secured perimeter, and neither were present during today's visit. The submitted facility sketch was consistent with the current layout of the facility. During today’s visit, LPAs, accompanied by the applicant’s representative, 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, sinks, and showers were in working order. The facility’s ambient internal temperature was complaint at 72 degrees F. Hot water temperature at taps accessible to residents were also compliant: Kitchen sink was 113 F, Bathroom #1 sink was 110 F, and Bathroom #2 sink was 111 F. The facility has enough linens, hygiene supplies, cooking and dining supplies, and perishable and non-perishable food for future resident use. All kitchen appliances were in working order. Kitchen Refrigerator temperature was 40 F, and Kitchen Freezer temperature was 0 F. Staff Refrigerator temperature was 21 F, and Staff Freezer temperature -18 F. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, 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’s representative, no firearms or ammunition are or will be stored at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. Fire extinguishers were serviced within the last twelve months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility. The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection. LPAs also provided the Component III Training during today’s visit. Tapia was advised that the facility’s application is pending management final review and approval. An exit interview was conducted with the applicant’s representative, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.