Pre-licensing visit·December 13, 2022

Licensing Program Analyst (LPA) Jill Nakagawa conducted an initial pre-licensing inspection and met with Simeon Boyd, the Licensee. The facility has a fire clearance approval from the Davis Fire Department of 5 nonambulatory, and 1 bedridden, for a total capacity of 6 residents. The facility has a Dementia Care Plan within their Plan of Operation. Facility will operate with hourly staff and Licensee will ensure sufficient staffing at all times. During today’s visit LPA observed the following items: · COVID-19 screening station with visitor log. · Lockable separate cabinets for medications, toxins/cleaners, and knives. · All exits were unobstructed. · 10 hardwired smoke detectors, which were tested and observed operational. · 2 carbon monoxide detectors, tested and observed operational. · Complete First Aid kit, night-lights, and flashlights for emergency lighting. · Supply of paper products available. · Fire Extinguisher charged. Component III orientation was completed with the applicant during this inspection. (cont'd on 809-C) Pre-licensing is incomplete with corrections needed The following corrections are needed to proceed with the application process: Required posting: CCLD complaint poster (PUB 475) in the required size 20" x 26". Required grab bars in bathrooms by toilets. Decrease Water temperature within regulation of 105-120 Degrees F. Closet door runner in Bedroom #1 needs to be replaced. Applicant to provide pictures of the corrected items as proof of correction to LPA Nakagawa. Once LPA receives the corrections, LPA will submit the pre-licensing application report and corrections to the Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of the application status. No deficiencies cited.