Pre-licensing visit·July 12, 2021

Licensing Program Analysts (LPAs) Karina Canela and Jill Nakagawa conducted a pre-licensing inspection on 07/12/2021. LPAs met with Applicant Salvador Ivan Hernandez, who will be the Administrator when the facility is approved for licensure. The facility has a fire clearance approval from the Woodland Fire Department for 3 non-ambulatory residents and 1 bedridden for a total capacity of 4. Facility will operate with live-in staffing and Licensee will ensure sufficient staffing at all times. During today’s visit LPAs observed the following items: · Lockable separate cabinets for medications, toxin, and knives. · All exits were unobstructed · 7 hardwired smoke detectors, 2 carbon monoxide detectors which were tested and observed to be operational · First Aid kit, night-lights, and flashlights for emergency lighting · Supply of linens, paper products, and hygiene supplies available · Grab bars and non-slip mats in 2 of 2 bathrooms. · Fire Extinguisher charged · Administrator Certification Report continued on LIC 809-C. LPAs Karina Canela and Jill Nakagawa notified the applicant that the following corrections must be made in order to proceed with licensure: · Chest of drawers needed in 2 out 3 bedrooms (bedrooms 2 and 3 on facility sketch) · Required postings (Personal Rights, Emergency plan/numbers, CCLD complaint poster, Client personal rights, Administrator certificate posted, and visitor policy). The Component III Orientation was completed during today's inspection. Pre-Licensing is incomplete with above items to be resolved by 7/19/2021. Applicant to submit pictures as proof of correction to Community Care Licensing Department (CCLD) for review. Once corrections are submitted and reviewed by CCLD, LPA will submit the pre-licensing report with proof of corrections to Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status.