Pre-licensing visit·July 1, 2022

At 10:30 a.m., Licensing Program Analyst (LPA) Melissa Ruiz conducted an announced Pre-License visit to the facility mentioned above and met with Administrator Mark Belmonte. An application to operate a Residential Care Facility for the Elderly was received. A fire clearance dated 4/21/22 was received for 6 ambulatory residents, one (1) of which may be bedridden. 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 five (5) bedrooms, all of which are designated for resident use. Bedroom five (5) is designated for one (1) bedridden resident. All resident bedrooms were observed to be appropriately furnished. There are three (3) bathrooms, two (2) of which are designated for resident use and one (1) staff use. The common areas were appropriately furnished, and lighting was adequate. The living rooms had televisions and comfortable furniture. Resident and staff records will be stored in a locked cabinet in a staff office. Medications will be centrally stored and locked in the kitchen cabinet. The fire extinguisher is in the kitchen and was last purchased 4/20/2022. There are dual smoke and carbon monoxide detectors throughout the facility, and at 10:45 a.m. they were tested and were deemed operational. There is a functioning telephone on the premises. An emergency exit plan/sketch is posted 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 70°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 designated laundry room along the hall that leads to the attached garage. There is a shaded sitting area in the fenced backyard for clients to conduct outdoor activities. 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 Mark Belmonte. A copy of this report was signed and delivered.