Pre-licensing visit·December 6, 2022

Licensing Program Analyst (LPA) Karina Canela conducted a pre-licensing inspection on 12/06/2022. LPA met with Applicant Jethro Nicolas, Applicant who will be the Administrator when the facility is approved for licensure. Additionally, applicants Nina Ortiz and Olivia De Guzman were present. The applicants have submitted a hospice waiver request for two hospice to the Centralized Applications Bureau for review and approval. The facility has a fire clearance approval from the Fairfield Fire Department for 4 non-ambulatory residents for a total capacity 4 (facility does not have approval to accept or retain bedridden residents at this time). Facility will operate with 24 hour/ 7 days a week staff and Licensee will ensure sufficient staffing at all times. During today’s visit LPA observed the following items: · COVID-19 postings and screening station at entrance · Lockable separate cabinets for medications, toxin, and knives. · All exits were unobstructed · 9 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 12/02/2022 · Required furnishings in all 4 resident bedrooms · Emergency food and supplies · Administrator Certifications; Required postings (Personal Rights, Emergency plan/numbers, CCLD complaint poster, 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.