Life Changerz

Type of visit: Prelicensing

On 07/24/24, Licensing Program Analysts (LPAs) Antonine Richard and Yolanda Rosser conducted announced visit to this home. LPA was greeted by applicant Shante Hunter and explained the purpose of today’s pre-licensing inspection visit. An application was submitted to CCLD on 11/08/23 in the initial license application for a Residential Facility for the Elderly, ages 60 years and above. The applicant requested a capacity of six (6) individuals, of which maybe five (5) non-ambulatory, and one (1) bedridden. Structure: The home consists of three (3) bedrooms, one (1) bathrooms, half 1/2 bathroom a one story home situated in a residential neighborhood. The home includes a living, dining, kitchen, and laundry area outside. The living room did not include a fireplace. The living area included recliner seating. The kitchen has a refrigerator and stove. The rear exterior is fenced throughout. The passageways, walkways, and steps are free from obstructions. Bedrooms Residents: The facility had Three (3) bedrooms for residents. There are two (2) bedrooms for non-ambulatory, and one (1) bedroom specific for the bedridden. All rooms include a twin-size bed, one (1) chair, one (1) night stand, and one (1) table lamp. All bedrooms are equipped with a ceiling light. All rooms had a dresser, which complies with the requirement of 8 cubic feet of space. All rooms had closets for ample storage. The room also included wall night lights. Evaluation Report Continues Bedrooms Staff: No bedroom is designated for live-in staff. Bathrooms: The home has one (1) bathroom and Half 1/2 bath. Bathrooms are accessible in all rooms. The bathroom have a working toilet, washbasin, and shower with grab bars and non-skid mats. Linens & Hygiene Supplies: Beds have the required linen supplies which include, pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. An adequate supply of linen is stored in the hall closet inside the bedrooms. Emergency Phone Numbers, Exit Plan & Menu: Emergency phone numbers. The exit plan and menu are posted and readily available for review throughout the home. There is one (1) fire extinguisher located in the kitchen one (1) in the living room and one (1) in the bedroom. A telephone line is available in one of the resident bedroom, living, and dining rooms. Emergency supplies and Personal Protective Equipment supplies are stored in the hallway. The applicant has an approved Infection Control Plan on file. Food Service: Dishes, cups, and flatware are stored in the kitchen cabinets, inspected, and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a locked kitchen drawer. Food supply is adequately stored in kitchen cabinets and consists of the can goods. The kitchen counters also had small appliances. Smoke Detectors: Smoke and carbon monoxide detectors throughout the interior space. Hardwired smoke detectors in all three (3) bedrooms and hallways. Carbon monoxide is in the living room area. Toxins: All toxins are locked and stored under the kitchen sink cabinet. Evaluation Report Continues Appliances: Stove burners, oven, washer, and dryer are working. The kitchen counters also had small appliances which includes toaster, and coffee maker. There is two (2) refrigerators in the home. The refrigerators measured a temperature of at least 40 degrees Fahrenheit for appropriate food storage. The home with electric fans and heaters. The living area has a cooling/heating split system. Water Temperature: The water temperature is 111.8 degrees F. throughout the kitchen and bathrooms. Medications, First-Aid Kit & Book: A first aid kit is stored in the medication cabinet inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze, and current first aid manual locked and inaccessible to residents. The resident's medications will be stored in a mental cabinet locked in the hallway room area and inaccessible to residents. Resident & Staff Files: The applicant is not handling the cash resources for residents. Records of staff and residents will be stored in a metal cabinet in the hallway room area. Reading Material, Games, Equipment & Materials: The facility has board games, books, magazines, and other recreational materials for the resident's use all stored in the hallway. Pool/Jacuzzi & Pets: There are no pets, jacuzzi, or pool in the fenced area. Evaluation Report Continues Fire clearance: A Fire Clearance inspection was conducted on 04/08/2024 approved for a capacity for five (5) non-ambulatory, and one (1) for bedridden. Component III: LPAs Richard, and Rosser, conducted the Pre-Licensing inspection along with the information provided about how to operate the facility within substantial compliance with Component III PowerPoint. LPAs Richard, Rosser observed the following corrections: · Outdoor furniture missing an outdoor umbrella - correction by 07/30/24 · Exterior cabinet missing the lock - correction by 07/30/24 An exit interview was conducted, and a copy of this report has been furnished to the applicant Shante Hunter. LPAs Richard and Rosser will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application. END OF REPORTthe state’s words, verbatim · CDSS document, Jul 24, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Interview Method: Telephone interview On 5/29/2024, applicant/administrator participated in COMP II. Identification of the applicant / administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant / administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, May 29, 2024