Facility Evaluation Report

On 2/21/25 at 9:30am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted a Pre-Licensing Inspection with the Licensee Ramirez Roberto. This is a Change of Ownership Application from facility #197610175 to #197610671 to operate an Residential Care Facility for Elderly (RCFE). A Change in Ownership (CHOW) Application to operate the RCFE was received by Community Care Licensing (CCL) on July 2nd, 2024. A fire clearance was approved on December 5th, 2024, for six (6) Non-Ambulatory residents. No approval for Bedridden resident. Facility has Hospice waiver granted for six (6) residents. The smoke alarms and carbon monoxide detectors are hard wired and inter-connected, they were tested and are operational. The facility has one (1) fire extinguisher that was purchased on 10/7/2024 and is located on the wall next to the kitchen island.

A tour of the physical plant was initiated at approximately 10:30am and the following was observed:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, gas stove, microwave oven and sink. There were adequate supplies of two (2) days of perishable and seven (7) days of nonperishable food, dining ware to accommodate a maximum capacity of six (6) residents. Knives and other sharps were observed locked inside kitchen cabinet next to the sink and chemicals observed stored inside locked cabinet under the sink. Kitchen area is open plan facing the dining areas.

COMMON AREAS: These include living room and a dining room. LPA observed the area was generally clean and organized. The living room was equipped with furniture, a television, tables and chairs. There is fireplace nicely fenced and blocked with a coffee table. The dining area has a dining table to accommodate six (6) residents. There were no visible immediate hazards. The facility has comfortable temperature which was measured at 10:50am to be 71 degrees F.