Pre-licensing visit·March 22, 2021

On 03/22/2021 at 10:27 AM Licensing Program Analysts (LPA) Stella Gutierrez conducted an announced follow-up pre-license tele inspection via FaceTime with Ernestine Hayes. The purpose of today\342\200\231s inspection is the change in physical plant operation where main care will be provided. Applicant was provided with a change of location inspection on 03/08/2021 and it was determined that main care area/ recreation room that is detached from the home is not permitted at this time. Main care area will be provided in home until the detached room is permitted and another inspection is conducted with Applicant with approval from CCLD. During today\342\200\231s inspection LPA, Gutierrez observed all recreational items that were provided in detached/non-permitted room to be relocated inside home/Living room area. Applicant was advised to sign a declaration stating that detached recreation room will be off limits until approved by CCLD upon completion of received permit and a follow-up inspection with assigned Analyst. Pending items needed post Pre license follow up visit: 1. Lease agreement 2. Declaration LIC 855 3. New Facility sketch showing that recreational room is off limits. 4. IMS Plan of operation 5. Pictures of the new main care area provided in the living room of home and detached room off limits. An exit interview was conducted, and a copy of this report was provided to the Applicant, Ernestine Hayes. Final decision of License issuance will be determined by the department unit Licensing Program Manager.