Pre-licensing visit·April 13, 2022

At 10:28 a.m., Licensing Program Analyst (LPA) Melissa Ruiz conducted an announced Pre-Licensing visit to the facility mentioned above and met with Administrator Renelyn Landicho. An application to operate a Residential Care Facility for the Elderly was received. A fire Clearance dated 03/10/2022 was received for 5 non ambulatory residents and 1 bedridden resident. The facility is a single story building. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: The facility has a total of seven (7) bedrooms, six (6) designated for residents and one (1) designated for staff. Resident bedrooms were observed to be appropriately furnished. There are 2 bathrooms, all designated for resident and staff use. All bathrooms were observed to have non-skid mats. The hot water was tested in the common bathroom and measured at 115°F. The common areas were appropriately furnished, and lighting was adequate. The living room has a television and comfortable furniture. Resident and staff records will be stored in a locked area in a cabinet along the hall. Medications will also be stored and locked in a kitchen cabinet. The fire extinguisher is in the kitchen and was serviced March 10, 2022. There are dual smoke and carbon monoxide detectors throughout the facility, and at 10:48 a.m. they were tested and were deemed operational. There is a functioning telephone on the premises. An emergency exit plan/sketch is posted throughout the facility along with other posting requirements. The first aid kit is readily available. Facility appears to be clean, in good repair and kept at a comfortable temperature of 69°F. Appliances in the kitchen appeared to be functional. There was a minimum of one week’s worth of nonperishable food to accommodate a maximum capacity of six (6) residents. There is a shaded sitting area in the fenced backyard for clients to conduct outdoor activities. There is a designated laundry room that leads to the attached garage. The laundry room stores linens and cleaning supplies. Component III was conducted during this visit. This report will be forwarded to the Centralized Application Bureau (CAB) for approval. Exit interview was conducted with Administrator Renelyn Landicho. A copy of this report was signed and delivered.