Pre-licensing visit·September 14, 2021

Licensing Program Analyst (LPA) A. Canela conducted a pre-licensing inspection and met with Applicant/Administrator Mark Jayson Sy. Fire clearance was approved by the Vallejo Fire Department on 8/9/2021 for a total of 6 residents, of which 3 are Non-ambulatory and 3 are Ambulatory. LPA successfully conducted a component III orientation with Mark Jayson Sy. LPA toured facility and observed: Facility is a one story home, in good repair and at a comfortable temperature. Hot water temperature checked between 107 and 108 degrees F in 2 out of 2 resident's faucets as required by Title 22 Regulations. The facility has a phone line designated for residents' use. Personnel and residents' records are stored at a locked kitchen cabinet. The home includes kitchen, dining area, 4 bedrooms, 2 bathrooms, living room, provider room/office and garage. Required posting for facility were observed, along with several Covid guidance posters. The facility has a table in front area by door with sign in sheet, hand sanitizer, thermometer and small garbage can. During today’s visit LPA observed the following items: · Lockable separate cabinets for medications, toxin, and knives. · All exits were unobstructed · 7 hardwired smoke detectors, 2 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 bathrooms. · Required furnishings in resident bedrooms · Fire Extinguisher charged and serviced 5/13/2021 · Administrator Certification for Mark Jayson Sy #6042012740 exp. 9/19/22 Mitigation Plan was received on 9/10/2021 and approved Pre-licensing is complete, no corrections needed and can proceed with licensure. Application Unit Analyst will notify applicant of application status.