Pre-licensing visit·August 29, 2024

Licensing Program Analysts (LPAs) Simi Rai and Marcela Yanez arrived announced to conduct the pre-licensing inspection. LPAs met with Applicants Justin Ladwig and Irish Ladwig The facility has an approved fire clearance for 5 non-ambulatory residents and 1 bedridden resident. During visit, LPAs toured the interior to include 6 resident bedrooms, 1 staff bedroom, 3 bathrooms (1 bathroom located in Staff bedroom), living room, dining room, kitchen, backyard, and front yard. All fire exit routes are free and clear of obstruction. Fire extinguisher, carbon monoxide detector was tested, and complete first aid kit observed present. Interior temperature maintained between 72 degrees Fahrenheit. Sufficient cups, plates, bowls, and utensils observed. Refrigerator temperature maintained at 43.9 degrees Fahrenheit. Bedrooms equipped with beds, linens, adequate lighting, chair, night-stand, and closet. Hot water temperature in the bathrooms ranged from 110.5 - 112.3 degrees Fahrenheit. Hot water temperature in the kitchen sink maintained at 110.1 degrees Fahrenheit. Bathroom shower does contain a non-slip mat and grab bars. Laundry room contains Laundry appliances and supplies will be in locked cabinet. Facility has an area to lock medications and records. Posters observed to include the licensing complaint poster, personal rights and rights of resident council. LPAs observed COVID-19 PPE supplies and emergency supplies, including flashlights. LPAs observed door alarm on exit doors. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. There were issues observed during today's visit. Based on facility sketch submitted, LPAs observed two areas noted on the sketch which were not present at the facility. One bathroom located between living room and staff room does not exist and dining/kitchen room was located at a different location on the sketch. LPAs observed one exit door located in between bedroom #4 & #5 which was not on facility sketch. Based on fire clearance approved, bedroom #1 and #2 are approved for non-ambulatory or bedridden. Applicants confirmed bedroom #6 is bedridden which is not specified on approved fire clearance. Applicants will submit an updated facility sketch with the appropriate changes which reflect the existing floor plan. Applicants stated they will reach out to Santa Clara County Fire Department to obtain clarification on approved fire clearance. Pre-Licensing is incomplete with issues to be resolved. A follow up Pre-licensure LIC809 will be generated upon resolution of issues.