Pre-licensing visit·September 6, 2024

Licensing Program Analysts (LPA) Luis Mora conducted an announced pre-licensing visit at the facility using the CARE Tool. LPA met with Nicole Axalan (Licensee) and Evan Cunanan (Licensee) explained the reason for the visit. A change of ownership application was submitted to the Community Care Licensing Department (CCLD) for a Residential Care Facility for the Elderly (RCFE) to serve six (6) non-ambulatory residents, of which one (1) may be bedridden, in the age range of 60 and over. Facility is approved for two (2) hospice waivers. A tour of the single-story facility included: kitchen, dining area, living room, laundry room, 4 resident rooms, 1 caregiver room, 1 resident bathroom, 1 staff bathroom, detached garage, front yard, and backyard. LPA toured the facility with Nicole and Evan, and the following was observed: the front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. Auditory devices were seen on exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in the residents’ bathroom and measured at 110.4 degrees F which is within the required 105 - 120 degrees F. The bathroom is clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in the hallway cabinets. Smoke detectors combined with carbon monoxide were observed in each room and throughout the facility and are properly operating. There are 2 fire extinguishers located in the kitchen and laundry room which are fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are kept locked under the kitchen sink and are inaccessible to residents. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. Cleaning supplies and toxins are locked in a cabinet in the laundry room and are inaccessible to residents. First Aid kit was fully stocked with current manual and it is kept in the hallway cabinets. (Continued to LIC 809-C) Residents medications are centrally stored in a locked cabinet in the kitchen. Residents and staff files are centrally stored in a locked cabinet in the dining area. LPA reviewed 6 residents’ medication and observed that medication properly documented and given as prescribed. LPA reviewed 6 resident files and 3 staff files. LPA observed administrator certificate for Nicole Axalan 6072466740 with an expiration date of 08/19/2026. No outstanding or pending items were observed by the LPA requiring additional pre-licensing visits. LPA will notify the assigned Centralized Applications Bureau (CAB) Analyst of the completed pre-licensing facility evaluation visit conducted, which included the Component III Orientation. Exit interview conducted and a copy of this report was provided to the licensee.