Pre-licensing visit·January 20, 2023

Licensing Program Analyst (LPA), Martha Arroyo conducted a pre-licensing visit to this property at 1:00pm on 1/20/2023 and met with applicant representative Loretta Tiede. The applicant has obtained fire clearance for a total capacity of five (5) non-ambulatory residents, and one (1) bedridden resident in bedroom #5 for a total capacity of six (6) residents. LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. At 1:26pm, all hard-wired smoke alarms and carbon monoxide detectors were tested and function properly. LPA observed two (2) fire extinguishers to be fully charged on 10/11/2022. There are six (6) single occupancy bedrooms for resident use. Five (5) bedrooms are inside the house while bedroom #6 is located outside in the backhouse. There will be no-live in staff. Facility will have 24-hour wake staff. Each bedroom is equipped with clean mattresses, pillows, and bedding. There is sufficient supply of linens, including blankets, bath towels and wash cloths. Bedrooms have sufficient lighting. The facility has four (4) bathroom for resident use. Resident bathrooms contained appropriate non-skid mats and grab bars. Bathrooms has sufficient paper products. Night-lights were present in the main hallway. Hot water measured at 109.4 degrees Fahrenheit at 1:22pm. LPA toured the kitchen area at 1:29pm. The facility has at least seven (7) day supply of non-perishable food. Appliances and all equipment appear to be clean and in good repair. Kitchen knives are stored in a locked drawer next to the oven. The kitchen has a sufficient supply of plates, cups, cook ware and utensils. Kitchen hot water measured at 114.8 degrees Fahrenheit at 1:41pm. The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. Enough seating for six (6) residents at the same time in the dining room table. A working telephone is present. There are activity supplies for future residents. Report Continued on LIC 809C... Report Continued from LIC 809... Medications will be stored and locked in a file cabinet next to the kitchen. First aid kit was observed to have bandages, thermometer, scissors, tweezers and a current first aid manual. Facility records will be stored and locked in a cabinet adjacent to the kitchen. Cleaning and disinfectants are stored and inaccessibly locked under the kitchen sink. Garage: The garage is attached to the house and will be locked at all times. Laundry area is located in the garage. Laundry detergents and cleaning supplies are stored and inaccessible to residents. There is an adequate supply of emergency water, along with emergency nonperishable food items kept in the garage. There will be no firearms/ammunition stored on the property. The facility has required postings, including emergency exit plan, Licensing Complaint Poster, Resident Personal Rights, Theft and Loss Policy, Resident Council Rights, and CDSS PINs. Facility has one central entry point designated for universal screening. Alcohol-based hand sanitizer available upon entry. Signs are posted throughout the facility to promote handwashing, and cough/sneeze etiquette. Facility has an adequate 30-day supply of Personal Protection Equipment (PPE). The exterior passageways were clean and clear of any obstructions. There are no bodies of water on the premises at the time of the visit . The LPA observed the backyard, which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. Physical plant is consistent with the submitted facility sketch/floor plan. During today’s visit, LPA reviewed facility’s program plan, personnel policies, abuse reporting procedures, in-service training protocol, and medication procedures. The physical plant of this facility location is in compliance with Title 22 regulations at this time. Comp III conducted in Licensee Representative. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. A copy of the report was provided.