The facility is a one story. At 11:16 am, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for five non-ambulatory residents and, one bedridden resident. The facility has five private resident bedrooms, Room #1 is a shared room, and Rooms #2, 3, 4, and 5 are individual resident rooms. Resident rooms #1, 4, and 5 have direct exits to the outside. Room #5 has an approved fire clearance for bedridden. Facility does not have a fire sprinkler system. Resident room #1 is set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. Applicant states that residents for rooms #2, 3, 4, and 5 will be bringing their own furniture. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are no designated staff rooms - awake night staff only. All rooms were free of odors. All window screens were clean and maintained in good repair.

There are four bathrooms. Bathroom #2 is in the hallway; bathrooms 1, 3, and 4 are attached to resident bedrooms #1, 4 and 5. Bathroom #2 will be used by residents and staff. The resident bathrooms have a shower with non-skid materials. The toilets and showers have grab bars. The hot water temperature was tested in Bathroom #2 at 115.4 F and in the kitchen at 110.8 F. Bathrooms #1, 3, and 4 do not have sinks installed at this time. Applicant will install, test the water, take video, and send to LPA.

Continued on 809-C

Kitchen knives are not present in the facility. Stove burners are rendered inaccessible to the residents by removing them when not in use and placed in a locked cabinet under the kitchen sink. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 33.5*F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash can has a tight fitting lid. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet located in the garage. No flies or other vermin were observed.

The common areas were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment, games and/or activity supplies in the living room. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. There were no rugs in the facility. There is a fireplace in the living room. It is screened and there are no tools. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they do not have central air conditioning. Applicant states window air conditioners will be installed in all resident bedrooms.

The facility smoke alarm system is hard wired. The smoke detectors and carbon monoxide detectors (2) were tested and functioned properly during the time of visit.

Continued on 809-C.

The laundry area is located in the garage. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in the bathrooms. Extra incontinence supplies are stored in garage. There is a functioning telephone on the premises, 805-439-0342. The emergency exiting plans/sketch are posted at the kitchen near the refrigerator. The emergency telephone numbers are not currently posted. Applicant will post a list, place on bulletin board in kitchen, take a photo, and send to LPA. Other required postings are posted at the kitchen bulletin board. The facility currently does not have a CCLD Complaint Poster. Applicant will obtain one, post it in a common area, take a photo, and send to LPA.

The exterior passageways were clean and clear of any obstructions. There is a covered (umbrella) patio area at the front of the house with tables and chairs where residents can sit. Applicant states a covering is being installed in the backyard and furniture will be placed near the covering. The backyard is fenced. The back and sides of the house are separated from the front yard by gates at the North and South side passageways. The gates to the front of the house are moved manually with self-latching mechanisms for persons to enter the front yard. There is a locked storage shed in the back yard used for paint storage. There are no bodies of water on the premises at the present time. The facility has two East facing gates leading to an extended backyard area. The bottom of the gates sit up higher than the ground and there is a gap of approximately one foot. Applicant stated that a board will be placed in front of the gap and landscaping will bring the ground up to the Northeast gate. Applicant will complete gate corrections and send photos to LPA.

The garage is accessible from the house; the doors were locked.

The items underlined must be corrected prior to licensure. Submit proof of corrections to LPA Chavez so that your application may be completed. Exit interview conducted and a copy of report emailed to applicant.