Harmonious Living

Type of visit: Prelicensing

On 01/17/24, Licensing Program Analyst (LPA) Antonine Richard conducted an announced visit to the facility for purpose of a pre licensing evaluation. LPA was greeted by applicant Debra Jones, Tianah Johnson, Pierre Malone, and explained the purpose of today’s pre-licensing inspection visit. An application was submitted to CCLD on 04/12/23 in the initial license application for a Residential Facility for the Elderly, ages 60 years and older. The applicant requested a capacity of six (6) individuals, of which four (6) ambulatory, Zero (0) non-ambulatory, and zero (0) bedridden. Structure: The home is a three (3) bedrooms, two (2) bathrooms, one-story home situated in a residential neighborhood. The home includes a living, dining, kitchen, office area, and laundry area. The living room had sofa, chairs, fire place and coffee table. The activity room area which included entertainment, and a big screen TV. The kitchen has a refrigerator Microwave and stove. The rear exterior is fenced throughout. The passageways, walkways, and steps are free from obstructions. LPA did not observe hazards, such as ladders, gardening tools. The patio contained one (1) table and four (4) chairs and big wood bench. Bedrooms Residents: The facility have three (3) bedrooms for residents. There are three (3) bedrooms for ambulatory residents and Zero (0) for the non-ambulatory. All rooms include a twin size bed, one (1) chair, one (1) nightstand, one (1) trash ban with a lid, 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. Evaluation Report Continues Bedrooms Staff: There is no bedroom designated for live-in staff. There is no staff lounge area. Bathrooms: The home has two (2) bathrooms. Bathrooms are accessible in all rooms. All bathrooms 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 are two (2) fire extinguishers located throughout the home. A telephone line is available in the kitchen, living, and activity rooms. Emergency supplies and Personal Protective Equipment supplies are stored in the cabinet. The applicant submitted a Mitigation Plan on 04/12/23. 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 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 six (6) bedrooms and hallways. One (2) Carbon monoxide and seven (7) smoke detectors. Toxins: All toxins are locked and stored in the laundry room in locked cabinets. Evaluation Report Continues Fire clearance: A Fire Clearance inspection was conducted on 08/31/23 approved for a capacity for six (6) ambulatory, (0) for non-ambulatory, and zero (0) for bedridden. Pre-licensing Checklist: Completed by licensee and reviewed by LPA. Component III: LPA Richard Conducted at the Pre-Licensing visit, along with the information provided about how to operate the facility within substantial compliance with Component III Power Point. During the pre licensing inspection certain items were observed which do not comply with applicable laws and regulations; the following items must be corrected and proof of correction shall be submitted to the CCLD office to the attention of, LPA Antonine Richard (Antonine.Richard@dss.ca.gov) (323-516-4092) by 01/23/2024. If additional time is required to complete noted items to correct, then the applicant will request an extension in writing prior to the due date. 1. Storage space (a) disinfectants, cleaning solutions poisons, medications, firearms and other items which could pose a danger if readily available to clients shall be stored and locked where inaccessible to clients. An exit interview was conducted with the Licensee Tianah Johnson, and a copy of this report has been provided. END OF REPORTthe state’s words, verbatim · CDSS document, Jan 17, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.