With the assistance of the administrator, a tour of the physical plant was initiated, and the following was observed:

The required posting were posted in the hallway, accessible to residents. The smoke and carbon monoxide detectors are dual and inter-connected. At 10:58am, smoke/carbon monoxide detectors were tested and observed to be functional. Facility is equipped with a fire door in the living room, leading to the hallway. During the smoke/carbon monoxide testing, LPA observed the fire door closing properly. The facility has a brand new fire extinguisher in the kitchen with purchase date of 04/21/25.

KITCHEN: The kitchen is equipped with brand new appliances, including a refrigerator, stove/oven, microwave oven, dishwasher, counter top oven, coffee maker. Knives were observed locked in a kitchen drawer. There was an adequate supply of non-perishable food items and supply of dishes in kitchen cabinets. Perishable food items are not required at this time, as there are no residents. Administrator was advised that facility needs to carry perishable food items once they admit residents for care.

Continued on 809-C

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

BATHROOMS: The facility has two (2) full bathrooms, one next to the office and the other next to the activity room. Both bathrooms were observed to have proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 115.9 and 116.6 degrees Fahrenheit.

COMMON AREAS: The living room and dining room are located by the entrance door. The dining room is located near the kitchen and has a table large enough to seat six (6) residents. Living room is furnished with couches, table, and television. There is a pantry in the hallway for storing water, food and other supples. Facility has an activity room, across from the bedrooms, furnished with couches and cabinets for games and a small exercise machine. Facility has internet and wi-fi access for resident's use.

LAUNDRY ROOM: There is a brand new washer and dryer in the laundry room with locked cabinets to store laundry and kitchen detergents and chemicals.

OFFICE: Facility's office is located in the hallway and includes cabinets to lock resident and staff records. LPA observed a safe in the cabinet for safeguarding resident P&I money. Medications will be kept locked in the office cabinet. There is a complete first aid kit and first aid manual in the medication cabinet.

SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of any obstruction. All entry and exit doors have a functional auditory alerts, when the doors open. The backyard of the facility is large enough to hold outdoor activities. LPA observed patio furniture, set inside a covered gazebo. There is no swimming pool or body of water. There is an attached garage to be used as storage. LPA observed an electrical generator in the garage. Facility has two exit doors in bedrooms 5 and 6, and an exit door at the end of the hallway, leading to the backyard, used for emergency exit.

In addition to the Pre-Licensing inspection, a Component III power point presentation was held.

Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report was provided to the administrator.