Pre-licensing visit·December 30, 2024

Licensing Program Analyst (LPA), Martha Arroyo conducted a pre-licensing visit to this property at 1:30pm and met with Applicant Representative, Rodolfo Ohide. This application is for a Change of Location (CHOL). The applicant has obtained fire clearance for a total capacity of six (6) non-ambulatory residents. The facility is a one-story home which will be licensed as a Residential Care Facility for the Elderly (RCFE). Currently, there are no residents residing in the facility. Starting at 1:32pm, the LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. At 1:55pm, all hard-wired smoke alarms and carbon monoxide detector were tested and function properly. The LPA observed a fire extinguisher last serviced on 01/22/2024. There are four (4) bedrooms for resident use; two (2) bedrooms are designated for single occupancy and two (2) bedrooms are designated for double occupancy. There is a staff bedroom for live in 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 two (2) bathrooms for resident use. Resident bathrooms contained appropriate non-skid surfaces and grab bars. Bathrooms have sufficient paper products. Hot water temperature was measured in both bathrooms and measured within the range of 105 and 120 degrees Fahrenheit. The LPA toured the kitchen area at 1:35pm. 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 cabinet. The kitchen has a sufficient supply of plates, cups, cookware and utensils. Report Continued on LIC 809C... Report Continued from LIC 809... 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. There is a fireplace present with a fireplace screen for safety at the time of visit. Night-lights were present in the main hallway and common areas. Functioning auditory alarms observed at the time of the visit. Medications will be stored and locked in a cabinet adjacent to the kitchen. Facility records will be stored and locked in a cabinet adjacent to the dining room. First aid kit was observed to have bandages, thermometer, scissors, tweezers and a current first aid manual. Garage: The garage is attached to the house and will be locked at all times. The laundry room is inside the garage. Detergents, disinfectants, and cleaning supplies are stored in a locked cabinet inaccessible at the time of the visit. 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, and Resident Council Rights. The exterior passageways were clean and clear of any obstructions. There are two (2) self-latching gates for emergency use. 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 with a table and chairs for resident use. Physical plant is consistent with the submitted facility sketch/floor plan. The physical plant of this facility location is in compliance with Title 22 regulations at this time. During today's visit, the Applicant Representative completed component III with the LPA. 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 reviewed and provided to Applicant Representative Rodolfo Ohide.