Pre-licensing visit·March 27, 2025

At approximately 9:30 AM, Licensing Program Analysts (LPAs) Julie Florio and Star Stevenson arrived announced to conduct a pre-licensing inspection and was greeted by Licensee/Applicant, Omar Chiong. 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 6 non-ambulatory residents. All bedrooms 1,2,3,4,5 are approved for non-ambulatory use. Facility has a dementia care plan. Licensee/Applicant is not currently in partnership with North Bay Regional Center (NBRC) or a placement agency but plans to look into this. At approximately 10:00 AM, LPAs initiated a tour of the facility and observed the following: Facility is a one 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. LPAs observed resident showers need shower curtain rods and curtains, Applicant agreed to purchase and install these prior at accepting residents into care. Applicant had non-slip mats and grab bars in place. LPAs observed a supply of clean linens, hygiene 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. LPAs observed 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. Continued on LIC809-C ... ...continued from LIC809... Applicant agrees to keep magnets and keys to these locked areas in facility safe secured and inaccessible to residents in care. Licensee agrees to maintain at least two days of perishable foods and currently has one week of non-perishable foods and an emergency water supply. The required posters were observed hanging in the facility entryway and licensee purchased a long-term care ombudsman poster during today's visit. Licensee was advised to post a copy of their admissions agreement and emergency disaster plan in common area of the facility. Licensee has suggested visiting hours and how arrangements can be made for alternative visiting hours. The facility currently has Applicant and two staff members associated to facility and will hire an additional staff member once license is approved. Applicant has been informed of association and staff transfer process. 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 computer area for residents in care and Applicant will provide an ipad for residents to use. Facility phone was tested and operational during inspection. Facility has a designated locked closet, as well as locked drawer and cabinet for centrally stored medications and resident, staff, and facility files. LPAs observed first aid kit, PPE, other emergency supplies, activity schedule, and games available for resident use. LPAs recommended that Applicant add additional, age appropriate activities for elderly residents. 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. The backyard features paved walkways and a shaded patio area for resident use. LPAs observed areas where lawn was not level with pavers in the backyard and Applicant agrees to fill these areas in prior to accepting residents in care. LPAs were granted access to backyard shed and observed furniture owned by the home owner from who they have a 5 year lease agreement. Windows, screens, and blinds were all observed in good repair. Applicant will submit proof of liability insurance once home is active, post licensure. LPAs observed a facility sketch which accurately reflects the floor plan. Applicant was not approved for bedridden residents by the local fire department. Continued on LIC809C... Continued on LIC809C... Applicant has since had the fire door installed as instructed by the fire department in order to be approved for a fire clearance which allows for the acceptance of bedridden residents. Applicant will submit a new LIC200 and facility sketch to the Department to request a new fire clearance. Component III orientation was conducted with the Applicant at facility where they conveyed knowledge and understanding of Title 22 regulations. The pre-licensing evaluation has been completed. License will be granted upon completion of a final review and approval from the Licensing Program Manager. Exit interview conducted with Applicant, whose signature on this document confirms receipt .