Pre-licensing visit·December 30, 2024

On 12/20/2024 around 2:15 PM, Licensing Program Analyst (LPA) L Holmes arrived unannounced to conduct a pre-licensing Inspection. LPA was greeted by one Care Staff, Administrator (ADM2) Elisa Empig, Administrator (ADM1) Tenzin Choney, and explained the purpose of the visit. Standard Certificate #6066920740 Exp: 09/15/2025. LPA and ADM1 toured the facility including but not limited to the common areas, dining room, bathrooms, kitchen, bedrooms and garage. The facility consists of five (5) residents. The residents were dining and watching television. Outdoor and indoor passageways were free of obstruction. There were not any bodies of water present. A comfortable temperature was maintained at 69 degrees Fahrenheit (F). LPA observed lighting in all areas to be adequate for the comfort and safety of the residents. The hot water temperature in the shared bathroom was measured at 109.9 degrees (F). The shared bathroom had paper towels, toilet paper, soap and garbage cans; all areas were safe and sanitary. PPE, sanitizer, and paper goods remain sufficient. There was a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. Smoke/carbon monoxide detectors were in operating condition during visit. Fire extinguisher was observed full and serviced 06/26/24. Emergency Disaster Plan is updated. Safety drills are rotational and last performed on 09/30/24. LPA reviewed four (4) staff files, and five (5) resident files. The following forms are to be updated and submitted to CCLD: -LIC500 Personnel Report & Resident Roster -LIC308 Designation of Administrative Responsibility (Reviewed) -LIC610E Emergency Disaster Plan (Reviewed) -An updated copy of Administrator Certificate(s) (Reviewed) -Liability Insurance (Reviewed) Exit interview conducted and a copy of this report provided to