Pre-licensing visit·September 27, 2021

Licensing Program Analyst (LPA) Ashley Smith arrived announced at 9:20 a.m. for a pre-licensing inspection. The LPA met with applicant Gilliana Sherman. This is a change of ownership application from Thousand Oaks Home Care IV (#565800711) to 254 East Sidlee LLC (#565850198). The current census is at 5 residents. The fire clearance was granted on 08/30/2021; in which all rooms were cleared for non-ambulatory clients, in which a bedridden person is permitted in Bedroom #1. Applicant successfully completed Component II on 09/10/2021 and completed Component III on 09/24/2021 with LPA Marth Guzman Chavez. The LPA toured the physical plant areas inside and outside with applicants to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN : Kitchen knives are stored locked and inaccessible in the closet in the hallway. The supply of perishable and nonperishable food is adequate. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. There is an adequate supply of emergency food. The facility recently completed a kitchen remodel, in which appliances and cabinets were replaced. BEDROOMS : There are seven bedrooms in the facility; there are six private bedrooms for resident use, and one staff room. The staff room is kept locked. All rooms have direct access to the outside. Lighting in the rooms appeared adequate. Five out of six private resident rooms were set up with beds, night stands, lamps, chests of drawers, chairs and closet space. BATHROOMS : There are three full bathrooms and one 1/2 bathroom. There are two (2) bathrooms for resident use; the half bathroom in the hallway and the full bathroom next to the staff room is designated for staff and guests. One out of the six resident rooms have an attached bathroom, and the other resident bathroom is in the hallway. BATHROOMS (CONT) : The bathtubs are equipped with nonskid surfaces and available nonskid mats. Grab bars were observed in the bathrooms. Hot water temperature measured in the two hallway bathrooms between 110.5 – 112.7 degrees Fahrenheit. COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. The facility smoke alarm system is hard wired; the smoke detectors and carbon monoxide detectors were operable at the time of the visit. There is a fireplace in the living room, which is appropriately screened. The fire extinguisher was fully charged and last serviced 05/17/2021. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted throughout the facility. Emergency telephone numbers are posted in the kitchen. Other required postings are posted in the hallway upon entry into the facility MEDICATIONS : Medications are in a locked cabinet adjacent to the kitchen. First aid kits were complete. FILES: Staff and resident files are stored locked and inaccessible in the medication cabinet. All resident and three staff files were reviewed at 9:40 a.m. and all records were in order. LAUNDRY : The laundry area is in the hallway, directly across from the designated staff room and bathroom. Laundry detergent and chemicals are stored inaccessible in a cabinet. GARAGE AND GROUNDS : The garage is locked and attached to the house. An additional refrigerator is in the garage with perishable items in good condition. The exterior passageways were clean and clear of any obstructions. There is a covered patio area in the backyard with tables and chairs for resident use. There are no bodies of water on the premises at the time . INFECTION CONTROL: The facility has a central entry point for symptom screening and sanitation station for staff, residents and visitors. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. Facility is in compliance with Title 22 Regulations at this time. The CAB Analyst will notify the applicant when the license has been approved. Exit interview conducted and report issued.