Pre-licensing visit·December 21, 2021

Licensing Program Analyst (LPA) Steve Chang conducted a pre licensing inspection visit, and met with administrator (ADM) Linda Miguel. Upon arrival, staff Melanie Gavina (MG) took LPA's body temperature, asked the infection control questionnaires, and checked LPA in guest book. ADM stated there is no residents in the facility. This facility address is currently licensed as a Adult Residential Facility (# 435202797). SARC is currently reviewing vendorization for RCFE application. LPA also informed applicant who also is the licensee of ARF (#435202797) to submit a letter of facility closure once this RCFE facility has been licensed. LPA toured the facility inside out with ADM. There are 3 shared bedrooms for residents, 1 bedroom for staff, and 2 restrooms in facility. Living room, family room, kitchen, laundry area and dinning area were observed in good repair. Not all trash cans were with covers. Not all paper towels with holder. ADM stated the facility will fix this issue in 2 days. ADM stated the facility will setup a screening station with PPE and visitor log book in 2 days. ADM stated facility will put the grab bars and non-skid mats in restrooms in two days. Room temperature was observed at 70 degree F, and hot water temperature was measured at 117 degree F. The facility is equipped with smoke and carbon monoxide detectors. ADM tested smoke and carbon monoxide detectors, and they were working fine. Fire extinguisher was observed, and was serviced on 04/10/2021. Medication closet, knives closet, and cleaning product closet were observed locked. PPE supplies were observed sufficient. LPA inspected backyard. There is no obstruction to block the walkway. ADM stated all staff were fully vaccinated and done with booster shots. Component III orientation was completed with ADM. No issues noted during inspection. Exit interview conducted with ADM, This report was provided to ADM for signature. A copy of this report was emailed to ADM.