Pre-licensing visit·September 14, 2021

On 9/14/2021 at 9:35 AM, Licensing Program Analyst (LPA) L. Ibo arrived unannounced to conduct continuation pre-licensing inspection due to a change of ownership. LPA met with caregiver S2, Administrator for Green Feathers arrived 30 minutes later, LPA informed the Administrator Merdith Castro, per Administrator she won’t be able to meet with LPA and she gave permission to LPA to give report to Kavitha Pramod. Facility has an approved fire clearance for 6 non ambulatory residents. Last fire inspection was conducted on 06/11/2021. LPA inspected the facility including but not limited to 4 resident rooms common areas, kitchen, dining and outside areas. Hot water measured at 110.5 degrees Fahrenheit. There was sufficient supply of perishable and non-perishable foods. First aid kit was complete. Component III was waived. LPA discussed with Applicant that since she is the Administrator for two other facilities (079200843 & 079200542) she can’t be the Administrator for this facility, then Administrator verbalized that she will give up her position as Administrator for facility 079200843 to be Administrator for Green Feathers Assisted Living. ....Continue to LIC809C... LPA observed the following: 10:00 AM LPA conducted records review S2 is not associated at the facility. LPA verified through guardian system, S2 stated training/working since June 2021. Applicant Kavitha Pramod corrected the citation and associated S2. 10:20 AM LPA observed locked side door on room #2. Applicant admitted that facility is using the pin to lock room #2 so that resident won’t go out on that door. Applicant took out the lock from the door and educated the staffs not to put the lock on the door/doors. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted with Applicant Kavitha Pramod and a copy of report was given.