Pre-licensing visit·March 28, 2026

On 3/28/26, Licensing Program Analyst (LPA) M. Medina arrived to the facility for an announced Pre-licensing (Change of Location) inspection. LPA met with Licensee, no residents in care at time of LPA's visit. LPA toured of the facility inside and out with Licensee. Facility is observed to be 6 bedroom, 2 bathroom house. Facility will have one private room, and four shared rooms according to facility sketch. Common areas were observed to be clean, furniture will be placed on the day of the relocation. Facility was well-lit throughout. Kitchen toured, LPA observed food storage and preparation areas to be clean and appropriate for food preparation. All kitchen items will be placed at time of relocation, facility has no dishes, utensils, cups, plates or food on site. Resident bedrooms were observed to have beds and portable closet space. Resident belongs will be placed in bedrooms on day of relocation. All linens, hygiene products and household items will be moved on day of relocation. Resident bathrooms toured, bathroom between bedrooms 2 & 3 observed to have grab bars in shower and near toilet. Shower is in need of skid resistant mat. Bathroom near kitchen has no grab bars near toilet or shower. Shower is in need of skid resistant mat. Water temperature measured at 134 degrees F. Carbon monoxide and smoke alarm detectors were installed and operational. Home is equipped with sprinkler system and pull station. Cleaning and chemical supplies will be locked and secured in kitchen cabinet and in the garage. Facility’s temperature read 73 degrees at time of visit. Fire extinguisher observed in the kitchen with a purchase date of 01/26/26. Continued on 809-C Outside of facility toured, Doors and passageways are clear and free from obstruction. Auditory alarms on bedroom exit doors are not audible. Exit gate from backyard to front of the facility is not self latching. LPA observed miscellaneous boards, cement pieces, ladder, sliding door screen in the backyard that need to be secured or moved. Patio was observed to be covered, a separate covered seating area was observed for smoking. First aid kit observed. Once relocated, medications will be locked in the kitchen cabinet. Pre-Licensing is complete with the following items to be resolved by 3/19/26: Remove and/or secure miscellaneous items from backyard Exit gate from back yard is not self-latching Auditory alarms must be audible from all exits of facility Grab bars to be installed near toilet and in shower Skid resistant mats for shower Pre-Licensing is incomplete with deficiencies to be resolved by 3/30/2026. A follow up Pre-Licensure LIC 809 will be generated upon resolution of deficiencies.. Exit interview was conducted with Licensee and a copy of report was provided for facility records.