Pre-licensing visit·December 22, 2021

Applicant JKMS, Inc. has applied for RCFE licensure for 4 elderly non-ambulatory clients--3 of whom may be bedridden--in 4 private rooms. Fire clearance has been approved for bedridden in rooms 1, 2, 4 only. LPA Jeung toured facility and grounds of this one level facility, which also includes 2 staff/office rooms, 2 common bathrooms, and open living, dining, kitchen area. All rooms are private, and 3 rooms have exit doors to outside. Washer and dryer are located in 2-car garage, where there are ample storage cabinets. This property is located on the corner of Southcliff Avenue and Newman Drive, and ramp is accessible from Newman Drive. Medications will be secured in rolled cart and toxins will be stored in locked garage cabinet. Food preparation and service items are present, as well as non-perishable canned vegetables and protein. Supply of bed and bath linens is observed. The following items are observed and must be addressed prior to licensure: 1. Grab bars for toilet and shower in 2nd bathroom are not installed. 2. There are no COVID signs posted: cough/sneeze etiquette, reminders to practice social distancing and wear masks. Signs posted during LPA's visit. 3. There is an insufficient 7-day supply of canned fruit on premises. Canned fruit supply added during visit. 4. Room doors are numbered and referenced in Emergency Disaster Plan (LIC610E), but there are no room numbers on bedroom doors. 5. Emergency Disaster Plan (LIC610E) is missing correct Ombudsman phone number, facility and alternate phone numbers, location of emergency keys, plan for evacuation of bedridden clients, location of fire extinguishers. 6. Facility sketch to be revised to correct exit doors. 7. Night lights are not installed in hallways and passages to nonprivate bathrooms. Installed during visit. Items referenced above to be addressed, and proof to be provided to LPA prior to licensure. Facility phone number is 650/636-4025, and must be included on Emergency Disaster Plan (LIC610E). Component III orientation is reviewed with Ms. Huertas and Ms. Makalintal today.