Facility Evaluation Report, 06/23/2022 — Granite Bay Villas II, Granite Bay CA

Licensing Program Analyst (LPAs) Lavinia Muscan and Talwinder Bains met with applicant, Shahbaz Khan, to conduct an announced Pre- Licensing visit. LPAs followed current Covid precautions- self screened, hand sanitized and surgical mask worn. LPAs were screened upon arrival. This application is a change in ownership. This address is currently licensed as Granite Bay Villas II Facility # 312700538 . Applicant holds a current administrator certificate (# 6062273740 with expiration date 01/27/2024).

LPAs conducted an inspection of the care home to ensure compliance with Title 22 regulations. Facility inspection is done for these areas but not limited to six (6) bedrooms , two (2) bathrooms, storage area ,outside area and laundry area . LPAs observed facility not to be properly furnished, as 4 bedrooms need renovation (pending paint work and minor fixture). Bathrooms were in sanitary condition and properly maintained. LPAs checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked . LPAs observed at least a 2-day perishable and 7-day nonperishable food supply at the facility. LPAs observed cleaning products and other toxins to be locked away. LPAs observed the area used for medication to be locked and inaccessible to residents. LPAs observed smoke detectors and carbon monoxide detectors at the care home are operational. Fire extinguisher is ready for emergency use.

Applicant has NOT satisfied all requirements in accordance to Title 22, California Code of Regulations due to renovation projects not being finished on today's pre-licensing inspection. Applicant stated that all renovation work will be completed by 7/7/22 and Applicant will notify LPA once facility is fully ready to complete the pre-licensing visit. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) that facility did not meet all the pre-licensing components yet. A copy of this report was provided to the facility. Exit interview conducted.