Kameron Place

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Kathleen Banrasavong conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. At 09:00 AM, LPA met with Licensee, Dhana C. Remot. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 03/27/2023 for a total capacity of six (6) residents. Fire clearance was granted on 06/02/2023. LPA Kathleen Banrasavong observed the following: Structure: Facility is a one-story house with five (5) resident’s bedrooms, two (2) resident’s bathrooms, living room, dining area and kitchen. There was an attached three car garage. There is not a pool. Heating/Cooling System: Central heating and air conditioning system are installed and operable. Temperature was set at 77 degrees. Bedrooms: Each resident bedroom #1, #2, #3, #4 were in good repair. Four (4) bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm and carbon monoxide alarms. Bathrooms: Two (2) resident’s bathrooms have a working toilet, wash basin, and shower with an adequate supply of paper towels, toilet paper, and hand soap dispensers. LPA tested the water temperatures in the resident bathrooms. LPA verified water temperature was measured at 108 degrees Fahrenheit. (CONTINUED ON LIC 809C) (CONTINUATION FROM LIC809C) Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp drawer will be secured in a locked drawer located in the cabinet. There was adequate room for food storage. LPA observed the stove and microwave to be operational. Refrigerator/freezer were in working condition. Pantry had sufficient storage for non-perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was in the garage. Laundry detergents and cleaning supplies were observed in a closet away from residents. Living/Family room: There was a living room with furniture for all clients. Linens and Hygiene Supplies: An adequate supply of linens and hygiene supplies was stored in a cabinet in the hallway of the residence. Yards/Outside: Patio table and chairs were observed in the backyard. There was a gate on the northwest side and a self-latching closure. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch were observed posted at the exits in the house. Ombudsman poster, Let-Us-No poster, Rights of Resident Council, Theft & Loss, Personal rights, Non-discrimination observed. General items: One (1) fire extinguisher was charged and located in the closet with signage; fire extinguisher was charged 12/12/2022. Seven (7) dual smoke alarms and carbon monoxide detectors were tested and were observed to be in working order. Client records will be stored in a locked closet. Three (3) First Aid kits with required components were observed. There was a locked area for medication storage. Emergency food and water supply was observed. Pre-Licensing is complete, and this facility has no deficiencies. An exit interview was conducted, and a copy of this report was given Licensee, Dhana C. Remot.the state’s words, verbatim · CDSS document, Sep 20, 2023

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for Elderly (RCFE) Application Type: Change in Ownership (CHOW) Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Dhana Remot, Applicant/Administrator Interview Method: Telephone interview On September 12, 2023 at 1:04 PM, 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. 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 Readiness Exit interview conducted with Applicant/Administrator. Copy of report sent via email and informed to sent signed copy end of business day today.the state’s words, verbatim · CDSS document, Sep 12, 2023