Pre-licensing visit·December 27, 2022

Licensing Program Analyst (LPA), Alviso conducted a pre-licensing inspection and met with Licensee/Administrator Mera Shaughnessey; Mera's administrator certificate #6010796740 is current and expires 12/15/2023. This application is a change of location of Allure Senior Care, to address 2008 Dennis Lane, Santa Rosa. Licensee has submitted documents as requested for the change of location application. Facility will have a new license number, #496890095. Facility has a fire clearance approval by the Santa Rosa Fire Department for a total of six non-ambulatory and/or bedridden-effective 12/5/2022. Facility has an approved dementia plan, and a hospice approval for three(3) residents. Facility will operate with an awake night staff and Licensee will ensure sufficient 24/7 staffing at all times. Hot water was checked at 112.8F which is within regulation. All exits were unobstructed in the home. Lights/power were on and operational. Cable television and phone service are to be transferred this Thursday, 12/9/22, a scheduled appointment, per Licensee. Currently, the facility has a cell phone for use as needed and internet connection for Hulu, Netflix, and Youtube, etc. There are nine(9) smoke alarms that are also carbon monoxide detectors, all were working appropriately during the inspection. Fire extinguishers, two (2) are fully charged as required, and tagged, 12/5/22. Continued on LIC809C... There was sufficient lighting throughout the facility in resident rooms, common areas, bathrooms, and hallways. The grounds were free of any apparent hazards, and exits were clear. No bodies of water. No firearms. LPA observed a closet for storing medications, this closet has a key lock securing the medications. All bathrooms had grab bars for resident use. Postings noted to be current and in compliance with regulations. Facility does have an infection control plan as required, and an emergency disaster plan; Facility does have a generator that can be used as needed for charging things like cell phones, batteries, lights/lanterns. Toxins/cleaners will be locked and secured and inaccessible to residents in care. Facility has a supply of Personal Protective Equipment (PPE) for use as needed. Station set up at front door area with sanitizer gel, and where a staff person on duty will ensure screening as needed. All postings required were posted, and visible upon arriving to the front entrance door outside of the facility and inside the facility. LPA requested the following updated forms to be submitted to Community Care Licensing by 12/30/2022: LIC 308 Designation of Facility Responsibility (1 person per form) LIC 500 Personnel Report LIC 400 Affidavit Regarding Client/Resident Cash Resources (indicate if not handling cash for residents) LIC 402 Surety Bond (if handling cash) LIC 610E Emergency Disaster Plan/Evacuation Plan LIC 9020 Register of Facility Residents Copy of current Administrator's Certificate Copy of Infection Control Pllan LPA conducted a component III orientation with Applicant Mera Shaughnessey. Pre-Licensing is complete and this facility has no apparent health hazards and/or concerns observed during this inspection. The application is approved for licensure, effective 12/27/2022.