Pre-licensing visit·January 7, 2025

At approximately 11:40 AM, Licensing Program Analysts (LPAs) Julie Florio and Star Stevenson arrived announced to conduct a pre-licensing inspection and was greeted by Licensee/Applicant, Joy Johansen. This pre-licensing inspection is being conducted for an initial licensing of an Residential Care Facility for the Elderly (RCFE). Fire Clearance has been approved for 3 non-ambulatory residents, one of whom can be bedridden and is approved for bedroom number 2 only. Facility has a dementia care plan and has applied for a Hospice waiver for 2 residents. Licensee/Applicant is not currently in partnership with North Bay Regional Center (NBRC) or a placement agency but plans to look into this. Licensee/Applicant already has one resident who would like to be admitted to the home upon facility receiving license. At approximately 11:55 AM, LPAs initiated a tour of the facility and observed the following: Facility is a two story home, was a comfortable temperature, and passageways were free from obstructions. Water temperature in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed resident showers with the required non-slip mats and grab bars in place. LPA observed a supply of clean linens, hygiene products, incontinent care products, and paper products available for residents. Hallways are equipped with night lights and residents' bedrooms have all the appropriate furnishings as outlined in Title 22 regulations. All resident bedrooms are located on the first floor. There is a sufficient amount of dishes and cooking supplies for resident use with sharps and other hazardous items kept secured in various designated drawers and cabinets as well as under the kitchen sink. Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked. Licensee/Applicant agrees to keep magnets and keys to these locked in facility safe secured and inaccessible to residents in care. Facility has at least two days of perishable foods, one week of non-perishable foods, and an emergency water supply. Continued on LIC809-C... ...continued from LIC809... LPAs observed a sample menu posted in the common area to indicate a healthy and balanced set of meals for residents in care. The facility has a designated cell phone on site and has internet services. Licensee/Applicant agrees to purchase an internet access device which will be designated for resident use. Facility has a designated locked closet for centrally stored medications and resident, staff, and facility files. LPA observed the facility's infection control plan, first aid kits, PPE, other emergency supplies, activity schedule, and games available for resident use. Facility has a fire extinguisher, which was last inspected 10/2024 and is fully charged. Smoke and Carbon Monoxide detectors were tested and operational during inspection. LPAs observed a generator for emergency preparedness. Licensee/Applicant has a baby gate installed making the upstairs area of the facility inaccessible to residents in care. Licensee/Applicant agrees to install a mounted screen in front of the gas fireplace to prevent residents from touching it. Licensee/Applicant has posted hard copies of the admissions agreement, emergency disaster plan and maps, personal rights information, and reporting posters in facility communal areas. LPA informed Licensee/Applicant that visiting hours shall be posted as well. The facility currently has Licensee/Applicant and one staff member associated to facility and will hire an additional staff member once license is approved. Licensee has been informed of association and staff transfer process. The backyard features paved walkways and a patio with a shaded seating for resident outdoor use. Windows, screens, and blinds are all found to be in good repair. Licensee/Applicant submitted a copy of the facility's lease agreement to the Centralized Application Bureau and will submit proof of liability insurance once plan is active post licensure. LPAs observed a facility sketch which accurately reflects the floor plan. Component III orientation was conducted with the Licensee/Applicant at facility where they conveyed knowledge and understanding of Title 22 regulations. The pre-licensing evaluation has been completed. Exit interview conducted with Applicant, whose signature on this document confirms receipt .