Pre-licensing visit·April 25, 2025

Licensing Program Analyst (LPA) Daniel Konishi made an announced visit and met with Licensee/Administrator, Yom Tekeste conduct an announced Pre-Licensing evaluation. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: An application was submitted to Community Care Licensing Department (CCLD) on for an initial application of a Residential Care Facilities for the Elderly (RCFE) to serve adults ages 60 and over. Approved for six (6) ambulatory, of which six (6) may be non-ambulatory residents. Structure: Facility is a single-story home located in a residential area consisting of four (4) bedrooms, three (3) residents’ bathrooms, kitchen, dining room, living room, family room, garage, and a backyard with seating and shade. Front entry and all exits have a wheelchair ramp. Operational Requirements: The facility did not have proof of liability insurance during today's visit and that they were instructed to obtain the liability insurance prior to accepting the first resident and will submit proof of that insurance to the department once it is obtained. Bedroom Clients: Bedrooms are equipped with a bed, nightstand, chair, lamp, dresser, trash bins, and overhead lighting. Bathrooms: Two (2) full bath equipped with working toilet, wash basins, bathtub/shower and two (1) full bath equipped with working toilet, wash basins, walk in shower. Linens & Hygiene Supplies: All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linens is stored in linen closets. Emergency Phone Numbers, Exit Plan: Emergency numbers and Exit plans are posted and readily available for review. One (1) fully charged fire extinguisher was observed. Facility has a land line telephone. Food Service: Facility has sufficient weekly supply of non-perishable foods. Dishes, cups, and flatware are stored in the kitchen cupboards, all equipment, inspected and in good repair. All equipment Knives, cutlery, and other sharp kitchen utensils were observed locked and inaccessible. Emergency water supply was observed. Carbon Monoxide/Smoke Detectors were observed and tested. Appliances: Refrigerator, oven, microwave, dishwasher and washer/dryer are in good condition. The residence is equipped with central heating and air conditioning. Toxins: Cleaning supplies, and toxins are locked only accessible to staff. Water Temperature: Hot water was tested in all bathrooms, and kitchen sink. Water temperature was within normal limits 105 degrees Fahrenheit and not more than 120 degrees Fahrenheit. Medication, First-Aid Kit & Book: Designated centrally stored medications cabinet, and 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. Resident & Staff Files: Designated area for files will be in locked closet. Pools/Jacuzzi/Body of Water: No bodies of water were observed. Fire Clearance: Fire clearance was approved on 12/11/2024 for six (6) ambulatory, of which six (6) may be non-ambulatory residents. Component III: Component III was reviewed during inspection. Pre-Licensing is complete, and this facility has no deficiencies. Exit interview was conducted with the Licensee/Administrator, Yom Tekeste and a copy of this report was provided.