Pre-licensing visit·August 13, 2021

Licensing Program Analyst (LPA) Cuadra arrived announced to conduct a Pre-licensing Inspection and Component III. LPA met with Applicant, Evelyn Serrano. LPA conducted risk assessment call prior to conduct the visit. LPA/Licensee toured the inside of the facility and grounds. LPA toured the facility with applicant Evelyn and observed the following. This is a one story residence with six bedrooms, two bathrooms, living room, family area room, master bedroom (resident's room), kitchen and dining eating area. Auditory alarms are on exit doors that were operational. Fire clearance granted by Vallejo Fire Department on 6/22/2021, granting capacity of six non-ambulatory. All rooms and common area had sufficient lighting, including hallways. The smoke alarms are hardwired and observed operational during inspection. Carbon Monoxide Detector observed and functioning. LPA observed fire extinguishers charged. Water temperature was measured at 106.2 F. LPA discussed per regulation water to be between 105 & 120 degrees F. There is a locked cabinet that will be used for medications. Binders for residents, staff and medication were observed in lockable cabinet. LPA informed cleaning supplies and toxins will be locked in a cabinet in the garage. Amble supply of linens, hygiene products, cooking utensils, pots/pans and dishes observed. Perishable and non-perishable foods observed per regulation. All bathrooms have non-skid flooring in showers. There is a seat on the shower for resident use for bathing. All appliances in the kitchen were working properly. Residents bedrooms had the required furnishings, such as a dresser, night stand, lamp and bed linens. LPA toured the large backyard area. Applicant informed LPA that facility won't handle cash for residents. Lolita's Pimentel Administrator Certificate 6018367740 expires 7/11/2022. LPA discussed facility's Disaster Preparedness with Applicant including observing their Emergency supplies. Applicant showed LPA the contents of their First Aid Kit. Continues on LIC809C... Continued from LIC809... LPA observed required postings (LTCO, CCL Complaint poster, visitor policy, employee rights and personal rights). in addition to COVID-19 required visitation postings. Facility has a sanitation station set up at the entrance to the facility in order to comply with Covid-19 precautions. Facility will be screening staff, residents and visitors for symptoms. The facility staff was observed wearing mask during the visit. Facility will provides assistance with family communication via telephone or video call. LPA reviewed their Mitigation Plan during this visit and approved. Component III Orientation was completed with Applicant. Pre-licensing passed and COMP III completed. Applicant has satisfied all requirements in accordance with Title 22, California Code of Regulation. LPA will provide this report to the Centralized Application Unit to continue application process. No deficiencies cited during today's inspection.