Pre-licensing visit·April 28, 2025

Licensing Program Analyst (LPA) Evelin Rios conducted a Pre-Licensing Inspection with the applicant representative / administrator, Phil Zhou and administrator designee Kazeem Abass. The applicant is "ASHTON HOME LLC ". This is a Change in Ownership "CHOW" application. A fire clearance was approved on 10/23/24 for six (6) non-ambulatory residents, one (1) of which may be bedridden in Room #3. The facility has a total of six (6) bedrooms and three (3) bathrooms. A tour of the physical plant was initiated at approximately 9:15 AM and the following was observed: KITCHEN: The facility has a Kitchen that is equipped with a refrigerator, microwave, stove, dishwasher and sink. There was an adequate supply of perishable and nonperishable food. Knives were observed locked in a kitchen cabinet. Cleaning supplies and other toxins were observed locked under the kitchen sink cabinet. BEDROOMS: There are five (5) bedrooms designated for residents use; four (4) private and one (1) shared. The bedrooms are furnished with beds, night stand, chairs, dressers, bedding and appropriate linens. The bedrooms have sufficient lighting and storage. BATHROOMS: The facility has three (3) bathrooms; one (1) is located in the shared bedroom. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water temperature was measured at 118.4°F, within regulation. LAUNDRY ROOM: The laundry room leads to the garage and is maintained locked. Laundry detergents and other cleaning agents were locked in a cabinets inside the laundry room. The garage was observed to be locked during visit. The facility keeps a second refrigerator and a freezer. (Continued on LIC 809-C) (continued from LIC 809) COMMON AREAS: These included the living room and the dining area. Living room was furnished with chairs and side tables. The living room area was furnished with a television, recliners and chairs that sit the capacity of the facility. There were no visible immediate hazards. There is a working telephone line and internet accessible to residents. Dual smoke/carbon monoxide alarms were tested at 10:15 AM and observed to be operational. Fire extinguisher was observed fully charged with service date of 01/09/25. MEDICATIONS: The medication cabinet is located in the kitchen and has a locking mechanism. Two first aid kits with manual were observed inside a hallway cabinet. LPA reviewed centrally stored medication records. Staff/Resident Records: Staff and resident records are kept locked in a filing cabinet. LPA reviewed resident and staff records for compliance. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alarms when the doors open. The backyard of the facility has two covered patios and backyard furniture to accommodate the residents. There are no bodies of water. Component III was conducted with the Administrator /Licensee Representative and Administrator designee. No deficiencies were observed during visit. This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. Copy of this report issued.