Pre-licensing visit·June 12, 2025

On June 12, 2025 Licensing Program Analysts (LPA) Deborah Lee conducted a pre-licensing Change of ownership (CHOW) evaluation for an RCFE facility type. Today’s pre-licensing evaluation was conducted with Albert Pimentel Narez. The licensee has applied for a license to serve ( 6 ) elderly residents ages 60 and over. The fire clearance is approved for ( 5 ) non-ambulatory and ( 1 ) bedridden on bedroom #4. A tour of the Kitchen, Dining Room, Living Room, (6) Bedrooms, (2) Bathrooms, Back Yard, and Patio with shade. The following was observed during this visit: Structure The facility is a single-story structure located in a residential neighborhood. It consists of the following: ( 6) residents' rooms, ( 2 ) bathrooms, a living area, a dining area, a kitchen, an outside seating area and an attached garage. Facility is clean, sanitary, and in good repair. Page 1 of 3 Indoor and outdoor passageways, stairways, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair, and areas of potential hazard are well-lit and equipped with sturdy hand railings. Smoke alarms operate properly. Carbon monoxide detectors operate properly. PHYSICAL PLANT LPA and Alberto Pimentel Narez toured the facility inside and outside. LPA observed there were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. LPA observed that facility had required postings: ombudsman poster, see something say something poster, emergency numbers, clients rights, employee Federal/State wage information, facility sketch, BEDROOMS LPA inspected all six (6) bedrooms. All bedrooms were observed to have the required furniture including beds, dressers, night stands, chairs, and ample storage space for personal belongings. No resident bedroom is a passageway to another room, bath or toilet. BATHROOMS LPA inspected the facility bathrooms. In the resident’s bathroom the toilet, faucets, and shower were fully operational. All safety handrails were securely fastened. LPA observed the showers to be clean and free of mold or mildew. The water temperature measured 109.4 -degrees Fahrenheit. Page 2 of 3 FOOD SERVICE Kitchen LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, washer, dryer, refrigerator, and additional freezer. LPA observed an ample supply of cutlery, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in locked drawers in the kitchen and are inaccessible to residents. LPA observed a 2-day supply of perishable foods and a 7-day supply of nonperishable foods. Cleaning products and toxins were secured in hall closet that is inaccessible to clients. MEDICATIONS There is a locked centralized storage area for Resident medications. RECORDS There is confidential storage of personnel records at the facility. There is confidential storage of resident records at the facility. LPA reviewed (3 ) staff files and found (3) out of ( 3) contained the required documentation, certification, and training. Liability Insurance expires on 11/14/25. LPA reviewed (3) resident files and found (3 ) out of (3 ) contained all the necessary documentation: Admission Agreement, Medical Assessments, Consent forms, ID, TB tests, Personal Rights, and Appraisal/Needs and Services plan. There are no corrections needed. Component III: Conducted during today’s Pre-Licensing visit. A copy of report provided was provided to Administrator. Page 3 of 3