Pre-licensing visit·February 16, 2024

Applicant Lilia Mauricio has applied for RCFE licensure for 6 non-ambulatory elderly clients over age 59 in 6 rooms. Fire clearance has been approved. Facility is currently licensed and operating under the name Apple Tree Home Care 2 #415600744, which is reflected on application (LIC200). There are 6 residents present; two residents receive hospice care. LPA Jeung toured facility and grounds of this one level facility. There are 6 private bedrooms--all with private half or full bathrooms and all with direct exits to outside--staff room, shower room, living room, dining room, and kitchen. There are 3 beds in staff room. Clothes washer and dryer are located in one car garage. The backyard is level, fenced and mostly paved, and supplies and paint are stored in detached storage shed, which is locked. Medications and toxins are secured in locked cabinets in kitchen and hallway, respectively. Food preparation and service items are present, as well as perishable and non-perishable fruits vegetables and protein. Supplies of bed and bath linens and hygiene products are observed. The following items are observed and must be addressed prior to licensure: 1. Complaint information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints (PUB475), shall be posted prominently in area accessible to residents, representatives, and the public. (87468 Personal Rights) 2. Admission agreement, modifications and attachments, or notice of their availability, must be conspicuously posted in a location accessible to public view in the facility. (87507 Admission Agreements) 3. An internet access device dedicated for resident use--such as a computer, smart phone, tablet, or other device that can support real-time interactive applications, equipped with videoconferencing technology, including microphone and camera functions--must be maintained. (HSC 1569.319) 4. A set of keys--including all resident units, facility vehicles, all exit doors, all cabinets, cupboards or files that contain elements of the emergency and disaster plan, including, but not limited to, food supplies and protective shelter supplies--must be available to staff on each shift for use during an evacuation. (1569.695) LPA to be contacted upon completion of the above 4 items. Revised Emergency Disaster Plan (LIC610E) is provided to LPA, which includes corrected utility shut off and fire extinguisher locations. Facility phone number is verified: 650/699-4010. Component III RCFE orientation is reviewed with licensee/administrator Lilia Mauricio and assistant administrator Joebelle Payumo. RCFE licensure is pending at this time.