Pre-licensing visit·October 22, 2025

At 09:20am, Licensing Program Analyst (LPA) Angela Panushkina and Licensing Program Manager (LPM) Nichelle Gillyard, arrived at the facility to conduct Pre-Licensing/Component III. LPA and LPM met with the Administrator and explained the reason for the visit. A tour of the physical plant was initiated at 09:30am and the following was observed: The facility is cleared for five (5) Non-Ambulatory and one (1) Bedridden (room #1) residents. Kitchen: The kitchen area is equipped with a refrigerator, microwave oven and sink. LPA and LPM observed there to be sufficient stock of perishable and non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. All knives and resident medications were observed to be locked in the kitchen cabinet. There is a complete first-aid kit with all required supplies. The fire extinguisher was last services on 08/11/2025 and observed to be full. Bedrooms: The facility has a total of six (6) bedrooms, five (5) of which are designated for residents’ use, and one (1) room is designated for live-in staff. The bedrooms are appropriately furnished with sufficient closet space and have sufficient lighting. All exit doors will have an auditory alarm which was observed operational and in good repair. Bathrooms: Facility has three (3) bathrooms. Bathrooms have soap and paper towels. Extra towels and linens were readily available. The hot water temperature measured at 120°F. Continue on LIC809-C Common Area: The facility maintains a comfortable temperature of 73°F. LPA observed all common areas are furnished with adequate furniture to accommodate a maximum capacity of six (6) residents. There is a functioning telephone on the premises. Smoke detectors are located throughout the facility. There are also two (2) carbon monoxides (one is located in the hallway and the second is by the kitchen) and at 10:20am they were tested and observed to be operational. Laundry Room: The laundry is located in the garage. The washer/dryer appears to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. Outside Areas: The back of the facility has sufficient yard space. At 10:45am, LPA and LPM observed appropriate outdoor furniture, with a covered shaded area for the residents. LPA discussed the importance of maintaining care and supervision to meet the needs of residents. The outdoor area had random items on the right side of the home and LPA/LPM advised the Administrator to clean or place them in a storage to prevent immediate hazards. There are no bodies of water. Component III was also conducted at 11:30am. During today’s visit, LPA and LPM observed the following that must be corrected prior to licensure: · Remove all cameras · Place a lock under the kitchen sink cabinet · Place a lock on a hallway cabinet, by room #2 · Update the facility sketch: room #3 - staff and staff – office · All trash cans must have a lid · Random items in the backyard must be removed · Outside furniture cushions have to be replaced · Walls/doors to be cleaned and or repainted · Outlet in room #3 and the office has to have a cover plate. Administrator agreed to make corrections and submit proof of picture by November 1 st , 2025. Once licensed the Administrator will purchase liability insurance and also submit a proof to LPA. Exit interview conducted and copy of this report signed and delivered.