Facility Evaluation Report

Licensing Program Analyst (LPA) Jerome Haley made an announced visit to this facility to conduct a pre-licensing inspection and Component III orientation. LPA arrived, was greeted and granted entry and stated the purpose of the visit. LPA met with Administrator (AD) Alexander Festin and Shirley Kniazeff.

About 2:05 PM, LPA Haley began the tour of the interior and exterior of the facility. There are six resident rooms at the facility. Resident rooms are equipped with all the necessary requirements: furniture in good repair, clean linen, adequate storage space, and kept free of tripping hazards. Auditory exit alarms were tested and are operational in rooms 2,3,4,5, and 6. Hardwired smoke and carbon monoxide detectors were tested and are operational. Bathrooms were clean, organized and in good repair. Bathrooms are equipped with grab bars, nonskid floor mats, soap, sanitizer, and paper towels. Hot water was measured in Bathroom #1: 114 degrees Fahrenheit and Bathroom #2: 116.6 degrees Fahrenheit. Facility has a well organized and labeled non-perishable food supply. Medications will be locked in a hallway closet inaccessible to residents in care along with first aid kits with all required elements . The Kitchen was clean and organized. All four burners on the stove are operational. Knives and sharp objects are locked in a kitchen drawer inaccessible to the residents. The garage was clean and very well organized. LPA observed an emergency supply of food, water, and PPE. Fire extinguisher was mounted and charged. The backyard had a shaded patio area with tables and chairs for residents to enjoy. The side exit gate was self closing and self latching. There was a pile of wood debris in the backyard. LPA advised AD Festin the importance of having the wood debris removed. AD Festin said all wood debris will be removed immediately and pictures will be provided to LPA Haley once removed..

On January 25th, 2022, The Orange County Fire Authority granted a fire clearance for three non-ambulatory residents and three ambulatory residents. During the visit the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations.

The Pre-licensing is complete, Component III was waived and the facility does not need any corrections at this time. The license will be granted upon completion of a final review and approval by the Centralized Applications Bureau. An exit interview was conducted, and copy of this report was left in the facility.