Facility Evaluation Report

Licensing Program Analyst (LPA) Arlene Garcia arrived announced to conduct a Pre-licensing visit on 11/12/21 and met with Christine Quirez, Licensee.

The facility will be licensed for a capacity of 6 non-ambulatory residents.

Licensee has facility in Manteca Jens Place Facility # 392700586 w here they will be moving clients to this new location once license is approved. Licensee has two bedrooms to show the set up and will move the remaining required furniture once license has been approved. Clients are currently using the furniture at the other location.

LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA did not observe residents during this visit.

Although there were no residents, LPA observed 2-day perishables and 7-day non-perishables.

The temperature inside the facility was observed to be at 69 *F which is within the required range of 68-85*F. The hot water temperature was measured at 117.7*F which is within the required range of 105-120*F.

LPA observed fire extinguisher(s) 5/4/2021,, smoke and carbon monoxide detectors, and central heating and air in the facility.

LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide.

Component III conducted- Licensure pending.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, copy of report given