Pre-licensing visit·May 5, 2026

Licensing Program Analyst (LPA) Angela Panushkina conducted a Pre-Licensing Inspection and met with the Administrator. Fire Clearance was approved on 10/28/2025 for a maximum capacity of six (6) residents. Bedrooms #1 & #2 approved for bedridden use. Bedrooms #3, #4 & #5 approved for non-ambulatory use. A tour of the physical plant was initiated at 09:20am and the following were observed: Common Areas: The facility maintains a comfortable temperature of 72°F. LPA observed all common areas (living room, dining room and office/sitting area furnished with adequate furniture to accommodate a maximum capacity of six (6) residents. Kitchen: The facility has a kitchen area that is equipped with a refrigerator, microwave oven and sink. LPA observed there to be sufficient stock of one-week perishable foods and two-day non-perishable foods. Food storage and preparation areas are clean and inaccessible to pests. The fire extinguisher is located by the kitchen/dining area and was last purchased on 10/01/2025. Medications: At approximately 10:10am, LPA observed medications are centrally stored and locked in kitchen cabinet and inaccessible to residents in care. The first-aid kit has been inspected which has at least the following: tweezers, scissors, antiseptic, bandages, gauze, thermometer; including a current First Aid manual. Bedrooms: The facility has five (5) bedrooms, of which four (4) bedrooms are private, and one (1) bedroom is shared. All bedrooms are furnished with beds, dressers and required bedding and linen. All bedrooms have sufficient closet space. Facility will have awake staff at night. Continue on LIC809-C Bathrooms: The facility has three (3) bathrooms. LPA observed all bathrooms have non-skid mats, soap and paper towels. Extra towels and linens were readily available. The hot water delivered in the resident bathroom measured at 111.6°F. Laundry Room: The laundry room is located in the garage. The washer/dryer appeared to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. Surrounding Grounds: The back of the facility has sufficient yard space. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There is a swimming pool that is fenced all around with a gate that is kept locked at all times. The fence surrounding the swimming pool is approximately 5 feet high all around. You will need a key to gain entry to the swimming pool as it is kept locked at all times. LPA discussed the importance of maintaining care and supervision to meet the needs of residents. Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 12:00pm they were tested and observed to be operational. Component III was conducted at 12:10pm. Pursuant to Title 22, Division 6 Chapter 2, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report will be provided. Exit interview conducted and copy of this report signed and delivered.