Pre-licensing visit·October 22, 2025

Licensing Program Analyst (LPA) Evelin Rios conducted a Pre-Licensing Inspection with the applicant representative / administrator, Marlen Lopez. An application to operate a Residential Care Facility for the Elderly was received by Community Care Licensing (CCL) on 05/06/2025. The fire clearance was approved on 09/24/2025 for six (6) non-ambulatory residents for a total capacity of six with a hospice waiver granted for six. A tour of the physical plant was initiated at approximately 12:30 p.m., and the following was observed: BEDROOMS: There are five (5) bedrooms designated for resident use. Bedroom #1 is shared. The applicant/administrator furnished the resident bedrooms with beds, night stand, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space. Passageways and exits from each bedroom is free and clear of any obstruction. BATHROOMS: The facility has two (3) bathrooms. Bedroom #3 has it's own bathroom with shower. All bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water in two (2) bathrooms was tested and measured between 108.5 and 111.4 degrees Fahrenheit within regulation. COMMON AREAS: These include the living room, sitting room and dining room. The living room is furnished with sufficient seating, couches, and table. There is a fireplace that is non-functional and the gas key has been removed. No fireplace tools present. The dining room table can accommodate the six (6) residents. Common areas were observed free from any hazards. Sitting area has a filing cabinet that is able to lock which will used to store resident and staff files. (Continue to LIC809-C) The smoke alarms and carbon monoxide detector are dual, hard wired and inter-connected. The facility has two fire extinguisher, located by the entrance and the kitchen/dining room area. The fire extinguishers were purchased on 03/26/2025. KITCHEN: The kitchen area is equipped with a refrigerator, stove/oven, dishwasher, microwave and sink. LPA observed sufficient amount of perishable and non perishable food items. There is an adequate supply of emergency food and water. There is also sufficient dining ware to accommodate the capacity of the facility. Knives and sharps were observed locked in a kitchen drawer. Cleaning supplies will be kept locked in a cabinet underneath the kitchen sink. First aid kit and manual will be maintained in a cabinet in the kitchen. LAUNDRY ROOM: The laundry room is able to lock. The laundry room has a washer and dryer. Detergents, and cleaning supplies will be stored locked in a cabinet next to the washer and dryer. Medications will be stored in a cabinet that is able to lock inside the laundry room. GARAGE: There is a detached garage, used for storage. Component III was conducted with the Licensee representative / administrator. Pre-Licensing is complete, and this facility has no deficiencies. This report will be sent to Centralized Application Bureau (CAB). 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 provided.