Facility Evaluation Report

At approximately 11:40 AM, Licensing Program Analysts (LPAs) Julie Florio and Star Stevenson arrived announced to conduct a pre-licensing inspection and was greeted by Licensee/Applicant, Joy Johansen. This pre-licensing inspection is being conducted for an initial licensing of an Residential Care Facility for the Elderly (RCFE). Fire Clearance has been approved for 3 non-ambulatory residents, one of whom can be bedridden and is approved for bedroom number 2 only. Facility has a dementia care plan and has applied for a Hospice waiver for 2 residents. Licensee/Applicant is not currently in partnership with North Bay Regional Center (NBRC) or a placement agency but plans to look into this. Licensee/Applicant already has one resident who would like to be admitted to the home upon facility receiving license.

At approximately 11:55 AM, LPAs initiated a tour of the facility and observed the following: Facility is a two story home, was a comfortable temperature, and passageways were free from obstructions. Water temperature in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed resident showers with the required non-slip mats and grab bars in place. LPA observed a supply of clean linens, hygiene products, incontinent care products, and paper products available for residents. Hallways are equipped with night lights and residents' bedrooms have all the appropriate furnishings as outlined in Title 22 regulations. All resident bedrooms are located on the first floor.

There is a sufficient amount of dishes and cooking supplies for resident use with sharps and other hazardous items kept secured in various designated drawers and cabinets as well as under the kitchen sink. Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked. Licensee/Applicant agrees to keep magnets and keys to these locked in facility safe secured and inaccessible to residents in care. Facility has at least two days of perishable foods, one week of non-perishable foods, and an emergency water supply.