Pre-licensing visit·March 27, 2023

Licensing Program Analyst (LPA) Teresa Camara conducted a pre-licensing visit to the above noted facility. The LPA met with applicant Anna Atayan. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver for six (6) has been requested. The facility is one-story. At 10:10 a.m. a physical plant tour was conducted inside and out. An approved fire clearance was received for five (5) non-ambulatory and one (1) bedridden resident. Any resident room can be used for the one bedridden resident. The facility has six (6) single-occupancy resident bedrooms and one office. All bedrooms have direct exits with a ramp to the outside. Resident rooms are equipped with required furnishing and are well lit. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room. There is no designated staff room, therefore there will be 24/7 awake staff. There are four (4) full bathrooms in the house. Each have roll-in showers with non-skid mats and grab bars. The hot water temperature was tested and found to be within the range of 105*F and 120*F; with an average of 105.9*F. The smoke detectors and carbon monoxide detectors were tested and functioned properly during the time of visit; fire doors all functioned properly. There were two (2) fire extinguishers located in the dining room and hallway purchased on 2/11/2023. Resident and staff records will be stored in a locked cabinet in the office. Medications will be centrally stored in a locked cabinet in the kitchen. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. The laundry area is located in the kitchen. Cleaning supplies are stored in the locked garage. The supply of extra bed and bath linens and incontinence supplies are stored in the hall closet. There is a functioning telephone on the premises. The emergency exiting plans/sketches are posted in each room near the door. The emergency telephone numbers are posted in the living room along with other required postings. The exterior passageways were clean and clear of any obstructions. There is a patio area with a table, chairs and shade. There are no other buildings nor a garage on the premises and no bodies of water. LPA conducted a Component III review with the applicant. The application is ready for completion. Exit interview conducted and report emailed to the applicant.