Pre-licensing visit·May 9, 2024

At approximately 12:15PM, Licensing Program Analyst (LPA) Julie Florio arrived at this facility announced for the purpose of completing a pre-licensing evaluation.. LPA met with Applicant Art Villegas and toured the facility. The facility is a 5-bedroom, 2-bathroom, single story house. Two bedrooms are shared rooms, one of which has a private bathroom. The facility has been approved for 6 non-ambulatory residents and 3 of which can be on Hospice. Fire extinguishers were charged and inspected April 2024. Smoke detectors were tested and in working order. There was a locked area for medications and several for toxins and cleaning supplies. Applicant informed LPA that he does not currently have a centrally stored medication log. LPA advised Applicant to obtain one from the CCL website. Beds were made but each was missing a mattress pad. LPA advised Applicant that each bed shall have a mattress pad per regulation. Resident rooms contained the required furniture in 5 of 5 rooms, however the trash cans were without tight fitting lids as required per regulation. LPA advised Applicant that all trash cans shall have a tight fitting lid. Hot water temperature was tested and found to be within regulation between 105 degrees F and 120 degrees F at faucets accessible to residents. This facility has an emergency disaster plan, infection control plan, dementia care plan. LPA observed an insufficient supply of emergency food and water to sustain 6 residents for 7 days as required per regulation. LPA advised Applicant to provide proof of the purchase of more of these items. LPA observed a weekly menu posted in a common area but was informed that the facility does not have an activity schedule at this time. LPA observed a supply of games and a karaoke machine present, and advised Applicant to provide an activity schedule to LPA. Component III orientation was conducted at facility. Applicant conveyed a good knowledge of Title 22 regulations. Applicant stated he will obtain liability insurance upon receipt of the License. Continued on LIC809-C Continued from LIC809 Applicant to submit proof of correction (POC) for each technical violation form LIC9102 provided before LPA will submit the application packet for a final review and approval from the Licensing Program Manager. Exit interview conducted. Copy of report and copies of each LIC9102 discussed and provided to Applicant. Signature on form confirms receipt of documents.