Viphealth Services

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Amy Goldenberg conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. An initial application to operate a Adult Residential Facility was submitted to the Central Applications Unit (CAU) on 06/14/2021 for a total capacity of 6 non-ambulatory residents. Fire Clearance was granted 07/09/2021 LPA Goldenberg observed the following: Structure: Facility was a two story house with four six (6) resident bedrooms, two bathrooms, living room, dining area, and kitchen area. Second floor will be office space and not for residents. Heating/Cooling System: Central heating and air conditioning systems. Bedrooms: All bedrooms were adequately furnished with bed, chair, large closets, appropriate linens, adequate lighting, and an operational smoke alarm. Bathrooms: Bathrooms have a working toilet, wash basin, and shower with an adequate supply of towels, toilet paper, and toiletries. Water temperature measured by applicant and thermometer read by LPA at 115 degrees F. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Cleaning supplies and knives/sharp instruments were secured in a locked cabinet and drawer. There was adequate room for food storage. Refrigerator/freezer were in working condition and had sufficient storage for perishable food. There was adequate seating for meals. Living/Family room: Furnished with safe and adequate seating and furnishings. All items appear to be in good repair. Linens and Hygiene Supplies: An adequate supply of linens was available. Yards/Outside: The back was completed was a patio with adequate covered area for providing shade. There were no obstructions. There were no bodies of water observed anywhere on the property. Garage: Laundry area with washer and dryer were located inside the home at the garage exit. garage. Laundry detergents and cleaning solutions were secured behind a locked cabinet door. Garage was organized and free of obstructions. Emergency Phone Numbers, and Exit Plan: Let-Us-No poster, emergency disaster plan are posted. General items: The smoke and carbon monoxide detectors were tested and operational. = LPA observed a facility phone and it was verified to be operational by LPA. LPA reviewed COMPONENT III with the applicant during this Pre Licensing Inspection. This facility physical plant is prepared for licensure pending clearance of the side yard, removal of side gate lock, and mounting of door alarms. This report was reviewed with and a copy was provided to the applicant.the state’s words, verbatim · CDSS document, May 25, 2022

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITL Capacity: 6 COMP II Participants: Sasis, Prince (Board member, Administrator) Interview Method: Telephone interview On 9/28/2021, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. 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, Sep 28, 2021