Pre-licensing visit·July 3, 2025

Announced Prelicensing visit made out to this facility on 07/03/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Luz Garibay, and Aileen Grimesey at this time. A brief interview was conducted with the facility designated Administrator at this time. It was learned that this facility was seeking licensure to accept and retain up to 6 non ambulatory residents at any given time. This facility does have an approved hospice waiver for (4) residents along with a dementia program that was submitted at this time. Current census was 0 residents. Tour of this facility was conducted. A tour of the facility kitchen area was conducted. Drawers and cabinets were opened and the items enclosed were reviewed at this time. Drawers housing knives and sharps were observed to be locked and made inaccessible to the residents at this time. Cleaning agents, bleach, and other supplies were observed to be locked and made inaccessible to the residents at this time. A review of the facility food supply was conducted. A review of the facility's 2-day perishable foods and 7-day nonperishable foods was conducted to make sure that there were sufficient quantities on hand at all times. Medication cabinet, located in the living room area, was reviewed. Policies and procedures involving handling, dispensing, and documentation of the resident medications were discussed with the facility designated Administrator at this time. A review of the facility Medication Administration Record and dispensing log was conducted. Medication cabinet was observed to be locked and made inaccessible to the residents at this time. Living room, dining area, and all other areas intended for resident use were observed to furnished and maintained in compliance at this time and able to meet the needs of the residents. A tour of the resident bedrooms was conducted. 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. Laundry room was toured at this time. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 6072036740 for Luz Garibay was observed to have an expiration date of 08/28/2026 and in compliance at this time. Forms and documents were being updated in order to renew this Administrator certificate at a later time. First aid kit, located in the medication cabinet, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher was observed to have been annually inspected by the local fire extinguisher company, Vallejo Fire Extinguisher Company, on 01/14/2025 and found to be in compliance at this time. Garage area was toured at this time. It was learned that this area would not be utilized by the residents at this time. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of the sample facility resident files was conducted. A review of the sample facility personnel files was conducted. This facility was observed to be in compliance at this time. Exit Interview