Pre-licensing visit·May 6, 2022

On 5/6/2022 at 10:00 AM, Licensing Program Analyst (LPAs) L. Francisco and K. Nguyen arrived unannounced to conduct a Pre-licensing Inspection. Upon arrival, LPAs were greeted by Care Staff, Rodora Suzon. Administrator, Fathma Ansar later arrived at 10:24 AM. The facility's fire clearance was approved for all six residents may be non-ambulatory. LPAs toured facility with Administrator and Care Staff including but not limited to 6 residents bedrooms, 2 staff rooms, 4 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 71 degrees F and hot water temperature was maintained at 107.6 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 11/1/2021. During record review, LPAs reviewed a sample of 2 residents and 3 staff records. 2 of 2 residents and 3 of 3 staff have current records maintained. The following were cited and corrected from a Case Management for existing license (#075601511 ): At 10:30 AM, LPAs observed two knives being stored inside dishwasher accessible to residents. Deficiency cleared during visit. Staff removed both knives and locked it away. At 10:33 AM, LPAs observed laundry detergent unlocked placed above laundry machines. Deficiency cleared during visit. Staff removed detergents from shelf and locked it away inside a cabinet. REPORT CONTINUES ON 809C LPAs 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 and a copy of this report provided.