Pre-licensing visit·January 24, 2025

Licensing Program Analysts (LPA) Cuadra and Elias Magdaleno arrived announced to conduct a pre-licensing inspection and was greeted by Applicant, Jessica Mendoza . Facility currently does not have residents in care. Once obtained, Applicant will submit proof of required liability insurance. The facility consists of a single story residence with a total of 2 bedrooms, 2 shared bedrooms (room #2 & #3 and #5 & 6), 2 full bathrooms, office, laundry room located in the garage, kitchen, dining room, and living room as common areas. Hospice waiver for two residents. The facility received a fire clearance approval on 9/9/2024 by the Santa Rosa Fire Department for 6 non-ambulatory residents in rooms 1-4, which none may be bedridden. Administrator certificate for administrator Angelica Martinez #6001706740 expires on 4/10/2025. Contact information reviewed. At approximately 9:15am LPAs/Applicant toured the building and grounds. The facility was found to be at a comfortable temperature. All resident rooms #1-4 are furnished per regulation with bed, lamp, bedside table, dressers and chairs. Garage houses storage, laundry, incontinence care supplies and emergency supply of water. Cleaning supplies will be stored in a cabinet located in the garage and locked cabinet located in the hallway. Office has locked door and cabinet with a lock that will be used for medication and file storage. Back deck is connecting to shared bedroom #5 & 6 and bedroom # 4 allowing access to the backyard, they have auditory alarms installed at the doors that were tested and operational during the visit. Water temperatures read at: 111.5 and 109.9 degrees F which is within 105-120 F degrees regulation. All bathrooms have grab bars and skid mats available. Kitchen cabinet has locks installed for knives to be inaccessible to residents in care. Smoke and carbon monoxide detectors present and functioning. Two fire extinguishers serviced on June 2024. Call pendants were available for residents and they were tested and operational. LPAs observed all required postings including the CCL Complaint Poster, Long Term Care Ombudsman Poster, Resident's Rights, and the rights to Resident and Family Councils. Night lights in hallway present. Activity calendar and supplies as well as sample of menu was observed. First aid kit present with all required items. Applicant has satisfied all requirements in accordance with Title 22 Regulations including Component III. LPA will notify Application Unit Pre-licensing inspection is complete to proceed with the process of license. Pre-Licensing is now complete. Exit interview conducted with Applicant and a copy of this report was given.