Pre-licensing visit·June 4, 2021

Licensing Program Analysts (LPAs) Karina Canela and Jill Nakagawa conducted a pre-licensing inspection on 06/04/2021. LPAs met with Applicant Arnel Silverio and Princess Diana Silverio, who will be the Administrator when the facility is approved for licensure. The facility has a dementia care plan and has submitted a hospice waiver request. The facility has a fire clearance approval from the Fairfield Fire Department for 5 non-ambulatory and 1 ambulatory residents for a total capacity 6. Facility will operate with a live-in staff and Licensee will ensure sufficient staffing at all times. During today’s visit LPAs observed the following items: · COVID-19 postings and screening station at entrance · Lockable separate cabinets for medications, toxin, and knives. · All exits were unobstructed · 12 hardwired combination smoke and carbon monoxide detectors, which were tested and observed to be operational · First Aid kit, night-lights, and flashlights for emergency lighting · Supply of linens, paper products, and hygiene supplies available · Grab bars and non-slip mats in 2 of 2 bathrooms. · Fire Extinguisher charged and serviced 07/24/2020 · Required furnishings in all 6 resident bedrooms · A shed in the backyard used for storage · Administrator Certifications; Required postings (Personal Rights, Emergency plan/numbers, CCLD complaint poster, Client personal rights and visitor policy). Pre-licensing is complete and this facility has no deficiencies . The Component III Orientation was completed during today's visit. LPA will submit the pre-licensing application report to Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status.