Pre-licensing visit·January 12, 2023

Licensing Program Analyst (LPA) Darius Williams conducted an announced visit regarding a Pre-licensing inspection. LPA Williams met with Administrator Mark Rivas and discussed the purpose of the visit. No clients were present or have been admitted. LPA Williams toured the facility with the Administrator. The tour began in the front of the facility. There were no obstructions or trip hazards. Upon entrance to the facility LPA Williams observed various signs regarding infection control, personal rights, house rules, visitation, etc., posted. The living room had seating for up to 6 clients, had space to move around, and had lighting. The kitchen had two tables with seating for 6 residents. The refrigerator temperature reflected 40 degrees Fahrenheit (F) and the freezer reflected 0 degrees F. The hot water from the kitchen faucet reflected approximately 105.1 degrees F. Cleaning chemicals are kept in a locked cabinet inaccessible to residents. Fire extinguisher reflected a service date of 9/7/2022. There are three bedrooms with two beds each. All beds have a mattress, mattress cover, fitted sheet, sheet, blanket, pillow, and pillow cover. There were two night stands and a chair in each room. There is one bathroom equipped with non-slip mats and grab bars. Towels are readily available to residents. *Continued on LIC 9099-C* The backyard has a covered area and was free of obstruction and trip hazards. Smoke detectors and carbon monoxide detector were all operational. First aid kit was present and had all required items. LPA Williams reviewed Component III with the Administrator. Pre-Licensing is complete and the facility has no deficiencies. At this time no License has been issued. LPA Williams will forward this report to the Central Application Bureau for further action. An exit interview was conducted and a copy of this report will be provided via e-mail.