Pre-licensing visit·February 6, 2025

***THIS IS AN AMENDMENT OF PRE-LICENSING REPORT DATED 02/06/2025.*** On 02/06/2025 at 10:00AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrive announced to conduct a Pre-licensing Inspection to verify corrections were made from visit on 01/28/2025. LPA met with Licensee, Filmon Yemane Gebrekidan/Administrator, Filmon Berhe Woldemariam. The facility’s fire clearance was approved for five (5) non ambulatory and one (1) bedridden resident. LPA toured facility but not limited to resident's bedrooms, bathrooms, living room, kitchen, and outdoor area. LPA observed all six (6) beds in residents’ rooms have blankets, bedspreads, top bed sheets, mattress pads and bedroom #1 to be complete with bed, chair and chest of drawers. LPA also observed signal system in kitchen and call buttons in residents’ rooms. LPA measured hot water at 109.2 degrees F. LPA observed paper towel with paper towel holders and night lights in residents shared bathroom. LPA observed facility does have resident rights/information -20"x 26" PUB 475 poster posted in entry of facility. LPA observed delivery date for outdoor table with umbrella is scheduled to arrive today on 02/06/2025. LPA observed mechanical lock in the backyard was removed and replaced. LPA conducted COMP III with Licensee and Administrator during visit. Continue LIC809C Continued from LIC809 The licensee/administrator was reminded of the statute that requires CCL to be notified within 5 business days of admitting their first resident. This notification may be done by phone, by mail, or by fax. No Issues were noted during inspection. 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 and a copy of this report provided.