Facility Evaluation Report

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. LPA Quiroz was greeted and granted entry and met with Administrator Vivian Ann Ortiz-Luis.

An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Unit (CAU) on 2/18/2021 for a capacity of six (6) residents, five (6) Non-Ambulatory residents; of which one (1) may be bedridden and hospice waiver for (6) six residents.

Administrator Vivian Ann-Ortiz Luis has an Administrator Certificate with expiration date of 9/8/2021. Administrator Ortiz-Luis indicated "Completed and submitted Certificate renewal on 7/2/2021, and waiting for new Administrator Certificate. Administrator Ortiz-Luis agreed to submit copy of new Administrator Certificate to CCL upon receiving new Administrator Certificate.

LPA Quiroz provided consultation on Title 22 California Code of Regulations (CCR) and on new Inspection Tool.

At approximately 10::37am, LPA Quiroz along with Administrator Ortiz-Luis commenced the inspection tour.

During today's inspection visit, LPA Quiroz observed the following:

Facility is a one story building. The first floor consists of: 6 private resident bedrooms, (1) one caregiver bedroom, (2) two full bathrooms, one (1) half bathroom. Bedroom #6 is designated as bedridden resident bedroom only. The resident bedrooms will accommodate residents' furnishings. There is one living room, kitchen with dining area, 2 car garage with operational washer and dryer, and back yard with outdoor furniture.