Pre-licensing visit·July 10, 2024

Licensing Program Analyst (LPA) David Marrufo conducted a Pre-Licensing visit and met with Josephine Yong, Administrator. LPA Marrufo reviewed the Component III presentation with Administrator Yong during visit. LPA Marrufo toured the facility inside and out. The kitchen had a perishable food supply of at least two days and a non-perishable food supply of at least seven days. The first aid kit was found to be complete. LPA Marrufo tested the smoke/carbon monoxide detector system and found it to be functional when tested. The outdoor area was toured and the exits were clear of obstructions. LPA Marrufo toured 3 out of 3 resident bathrooms. Each bathroom had functioning lights and available soap and paper towels. The water temperatures in 2 out of 3 bathrooms were 115 F and 119 F. During visit, LPA Marrufo observed 1 out of 3 resident bathroom sinks was clogged. LPA Marrufo reviewed records for residents R1-R5 and found residents R2, R3, and R5 did not have completed Safeguard for Property and Valuables forms. Resident R3 had a prescribed medication that was not in R3's Centrally Stored Medication and Destruction Record. During visit, the licensee of the new facility stated that the rest of the 13 resident records are not separated and completed in their own resident records. LPA reviewed the staff record of staff S1, which was found to be complete. The licensee of the new facility license stated the 4 out of 5 remaining staff did not have separate and complete personnel records. Pre-Licensing is incomplete with deficiencies to be resolved by 07/17/2024. A follow-up Pre-Licensing LIC809 will be generated upon resolution of deficiencies. This report was reviewed with Josephine Yong and a copy of this report was provided.