Pre-licensing visit·July 5, 2023

Announced Prelicensing visit made out to this facility on 07/05/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the Applicant Emma Villamil. Brief interview was conducted with the facility Applicant at this time. This Applicant was seeking licensure for a 6-bed RCFE non ambulatory with an approved dementia program and hospice waiver for (6) residents at any given time. A bedridden fire clearance was also granted for (2) residents at any given time with designated bedrooms. Tour of this facility was conducted. Kitchen area was toured. Cabinets and drawers were reviewed. Knives were properly stored and locked in a cabinet made inaccessible to the residents at this time. Food supply was reviewed for the adequate 2-day perishable and 7-day nonperishable quantities at this time. Fire extinguisher, located in the kitchen area, was observed to have been purchased from a department store with the receipt attached. It was observed that it was purchased on 04/03/2023 and in compliance at this time. Living room, dining area, and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. Resident bedrooms were toured. Bedroom furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Resident restrooms were toured. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. Grab bars and non skid mats were observed to be present and able to meet the needs of the residents at this time. Garage area was toured. It was observed that the laundry machines, washer and dryer, were present. All cleaning agents were observed to be locked and made inaccessible to the residents at this time. A review of the medication closet, located upon entrance to this facility, was observed to be locked and made inaccessible at this time. A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits were conducted. First aid kit was observed to be present and contained all of the required components at this time. The following forms and documents were requested to be updated and submitted into CCL at this time: LIC 308 LIC 400 LIC 500 LIC 610 This facility was found to be in compliance at this time. The Component III was waived at this time since this Applicant has been a Licensee prior to this location change request. Exit Interview