Pre-licensing visit·June 11, 2024

Licensing Program Analyst (LPA) Evelin Rios met with Romuel Neria (Applicant/Administrator) for a Pre-licensing inspection. On 02/06/2024 the Department substantiated the allegation of Unlicensed Care. The Operator Romuel submitted an application to the Department to become licensed on 02/22/2024. There is one resident residing in the home. The facility has 4 bedrooms and 2 bathrooms. Fire clearance is for 5 non ambulatory residents and one room is designated for one bedridden resident for a total capacity of 6. Rooms available are for private use of which two may be shared. There is a dementia plan of operation. There will be a wake night staff. Entrance interview conducted. LPA conducted a physical plant tour of the facility inside and out and the following was observed: Common Areas: Upon entry LPA observed appropriate facility postings. LPA observed the facility to be clean and furniture to be in good condition. LPA did not observe any obstructions throughout the facility. There is a fireplace with a screen. The facility phone was operational. There are two dining and sitting areas that accommodate the capacity of the facility. LPA toured the outside backyard grounds. LPA observed appropriate outdoor furniture with an umbrella for shade. There are no bodies of water. Bedrooms: LPA observed all bedrooms to be clean with appropriate lighting, closet space, chairs, night stands, and window coverings with screens. LPA observed one bed in one of the shared bedrooms with appropriate bed, mattress, bedding, and dresser. LPA reviewed a purchase receipt for five beds, mattress and dressers with delivery date scheduled between 06/14/2024 and 06/24/2024. Extra linens, toiletries and first aid kit were observed in a linen closet by the bedrooms. LIC809 Continued on next page. The smoke alarm and carbon monoxide detectors were tested by applicant at 10:36 a.m. and were observed operational. Three fire extinguishers appear to be fully charged with purchase date 02/08/2024. The facility maintains a comfortable temperature at 76 degrees F which meets regulation. Bathrooms were observed clean and supplied with toilet paper, hand soap, paper towels and hot water taken at 11:33 a.m. measured at 115.9 degrees F. Showers in both bathrooms have appropriate non-skid mats and grab bars. One out of the two toilets have a commode with grab bars. Kitchen: LPA toured the kitchen area LPA observed a sufficient amount of food and water supply. LPA observed the sharp knives in a locked kitchen drawer inaccessible. LPA observed cleaning chemicals locked in cabinet under the sink. The stove oven and the refrigerator were clean and in good operation. Laundry Room and Garage: The laundry room and garage are accessible to residents. LPA observed a washer a dryer that appeared operational. LPA observed laundry detergents locked in a cabinet in the garage. LPA observed extra supply of water in the garage. LPA observed tools looked in a supply closet in the garage. Medications and medication records are kept centrally stored and locked in a cabinet by one of the dining areas. Resident and staff records are kept locked in a cabinet by one of the dining areas. Component III Orientation with the Administrator/Applicant was also conducted during the visit. The licensee will need to complete the following: 1. Grab bar for the toilet in the private bathroom. 2. 4 bedrooms fully furnished and furniture arranged appropriately. Submit by June 25, 2024. Pre-licensing is incomplete with deficiencies to be resolved by 06/25/2024. A follow up Pre-licensure LIC809 will be generated upon resolution. Exit interview conducted and copy of this report signed and delivered.