1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25 | Licensing Program Analyst (LPA) Nacole Patterson conducted an announced Pre-Licensing visit. LPA was met by Applicant Luka Subotic and was granted entry into the facility. The purpose of today's visit was to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. The fire inspection was completed on 5/2/24 and the facility is approved for 6 non-ambulatory residents, 4 of which may be bedridden in rooms 1-4. The facility has an approved Hospice waiver for 6 residents.
During today's visit, LPA toured the facility and inspected all common areas, outside spaces, and a sampling of resident rooms across the facility. The facility was found to be clean, safe, and in good repair with no pathway obstructions. Private and common resident bathrooms were observed to be clean and the toilets and showers were found to be in working order. The facility's water temperature in a sampling of resident bathrooms and kitchen were measured at 117.2 and 118.5 degrees Fahrenheit. LPA observed locked storage areas where all hazardous and/or toxic chemicals were stored and secured. LPA observed locked storage for resident medications and files. Fire extinguishers were observed throughout the facility and found to be in compliance. A functioning carbon monoxide detector and smoke detectors were observed in the facility. No bodies of water were observed near or on the premises. LPA observed 7-day supply of
non-perishable food. Required postings were observed in a common area of the facility. LPA reviewed the applicant's Infection Control Plan and Emergency Disaster Plan.
LPA conducted Component III with the applicant. The topics discussed were continuing operation
requirements, record keeping/reporting, and physical plant compliance.
Pre-licensing is complete, and this facility has no deficiencies. It is recommended that this facility be licensed pending final review and approval. An exit interview was conducted with the Applicant Luka Subotic, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22). |