Pre-licensing visit·April 19, 2024

Announced Prelicensing visit made out to this facility on 04/19/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility Applicants, Chai and Orchid Damichob, who were briefly interviewed. This LPA later met another facility staff person, Cecil De Lara, who will be the facility designated Administrator. Current census was 0 residents. It was learned that this facility will be seeking to accept and retain up to (5) residents under the care of hospice at any given time. It was learned that this facility will have a program to be able to accept and retain dementia resident at any given time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility employee office, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Additional food storage units were observed to be present and functional at this time. Laundry area, located in the garage area, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 6066497740, for Cecil De Lara was observed to have an expiration date of 03/21/2025 and in compliance at this time. Medication cabinet, located in the facility kitchen area, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the kitchen cabinet, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguishers, located throughout this facility, were observed to have been annually inspected by the local fire extinguisher company, Armor Fire, on 01/21/2024 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. This LPA observed an additional storage shed that were present on the north side of this facility at this time. This storage shed was observed to be locked and made inaccessible to the residents at this time. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 This facility was found to be in compliance at this time. Exit Interview