Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct Pre-Licensing Inspection and Component lll. LPA met with applicant Alma Dichoso during inspection. This pre-licensing is for a change of ownership. There are five clients in care. Facility has a Dementia Care Plan approved to care for residents with dementia care needs. Hospice waiver is approved for 4 residents.

The following items were reviewed during this pre-licensing inspection:

Smoke detectors and carbon monoxide were inspected in residents rooms and in hallway which were all working properly

Fire extinguisher was last charged and serviced on January 2022

Water temperature measured 111.2 degrees F which was in regulation

Client files including Physician's Reports and Care Plans.

Facility kitchen including perishable and non-perishable foods.

Pre-licensing passed and COMP III completed. Applicant has satisfied all requirements in accordance with Title 22, California Code of Regulation.

LPA will notify CAB of today’s Pre-licensing inspection. No deficiencies cited at today’s inspection.