Pre-licensing visit·April 22, 2025

At approximately 8:50 AM, Licensing Program Analyst (LPA) Robert Frank arrived to conduct an unannounced Pre-Licensing visit and met with Caring Hands House Manager/Pending Administrator Karen Sims. Applicant Rose Woodward was out of town during the inspection. LPA spoke with applicant via telephone. Applicant stated that Karen Sims would become facility Administrator post-licensing. Applicant has applied for a Change of Ownership for an existing Residential Facility for the Elderly (RCFE) identified as Villas at Cloverdale (496803142). Facility currently provides care to older adults and has a dementia care program on file. Facility received an approved fire clearance dated 10/30/2024 that allows for a total capacity of six (6) non-ambulatory residents. Upon arrival, LPA was informed that there are currently four (4) residents in care. LPA conducted a physical plant walk-through. LPA observed the following: Per facility sketch, facility is a one (1) story residence with four (4) resident bedrooms, two (2) bathrooms, and common areas. Facility has one (1) small separate building on-site used for storage. The garage has been turned into a staff break area. Facility was found to be clean with all exits free from obstruction. Facility had emergency lighting. Facility's door alarms were tested and operational. LPA observed required postings including the CCL Complaint Poster and Personal Rights. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Facility's hot water temperatures for all sinks were within Title 22 Regulations of 105F to 120F. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Bathrooms were equipped with necessary grab bars and non-slip floors/mats were present. All resident rooms were furnished with a bed, lamp, dresser, and chair. Continued on 809-C... ...Continued from 809 Facility has sufficient items for cooking and eating. Facility has indoor/outdoor areas for visiting and activities. Facility's fire extinguishers were observed to be fully charged with an inspection date of 10/11/2024. Facility's smoke and carbon monoxide detectors were tested and operational. LPA confirmed that contents of the facility's First Aid Kit were sufficient. Component III orientation was conducted at facility with Karen Sims. LPA and House Manager discussed the following items: · Hospice Waiver - Applicant to apply for a waiver if it's decided they want hospice care in the facility · Updated Admission Agreements and Care Plans - Applicant understands that they will need to complete new Agreements and Care Plans for all residents once Facility License is approved. · Guardian background clearances and associations - Applicant understands that all current staff members associated to Villas at Cloverdale (496803142) will need to be transferred and associated to new facility license once approved. · Documents required to be submitted to Community Care Licensing for a change of Administrator. Karen Sim's Administrator Application (6077091740) was received by Community Care Licensing on 4/8/2025. No Deficiencies or Advisories given during visit. Pre-Licensing completed. Facility is ready to be Licensed as an Residential Facility for the Elderly (RCFE). LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status. Exit interview conducted. Copy of report discussed and provided House Manager/Pending Administrator Karen Sims. Signature on form confirms receipt of documents.