Pre-licensing visit·August 25, 2021

At 11:15 am, Licensing Program Analysts (LPAs) Melissa Ruiz and Angela Panushkina conducted an announced Pre-Licensing visit to this facility. This is a change of ownership application. Entrance interview with the Administrator Emma Apolinario was initiated. At the time of this visit, LPAs were screened with proper infection control protocols. LPAs observed three (3) residents at the facility. Fire Clearance dated 07/30/21 was received for six (6) residents, five (5) of which are non-ambulatory and one (1) bedridden. The facility is a two story building. Today's site visit consisted of LPAs touring the physical plant inside and outside and observed the following: The facility has five (5) bedrooms downstairs designated for resident use. The upstairs area is designated for staff only. Resident bedrooms were observed to be appropriately furnished. There are three (3) bathrooms in the facility and all were observed to have non-skid mats and appropriate grab bars installed. All trash cans were observed to have closed lids. The living room has a television and comfortable furniture. Resident and staff records will be stored in a locked cabinet near the kitchen. The fire extinguisher was observed to be fully charged and was serviced on 07/26/2021. At 11:33 am the hot water was tested and measured 116.9°F. Smoke and carbon monoxide detectors were tested and observed to be operational at 11:35 am. There is a functioning telephone on the premises. An emergency exit plan/sketch is posted by the entrance wall with other posting requirements. Medications are stored in a locked cabinet in the kitchen area. The first aid kit is readily available. LPA observed there to be a sufficient amount of perishable and nonperishable food. Facility appears to be clean, in good repair and kept at a comfortable temperature of 78°F. Necessary precautions have been made to the facility to safely house dementia residents such as auditory alarms on all doors. There is a shaded sitting area in the backyard. The backyard is fenced. The attached garage is kept locked and inaccessible to residents. Component III was conducted with the administrator. At this time, this facility is in compliance with Title 22 Regulations. No health and safety issues were noted. This report will be forwarded to the Centralized Application Bureau (CAB) for approval. Exit interview was conducted with Licensee Representative Emma Apolinario and a copy of this report was provided.