Pre-licensing visit·July 24, 2023

At approximately 8:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility for the purpose of completing a pre-licensing evaluation. LPA met with Applicant Jessica Grinberg and toured the facility. The Facility is a 4-bedroom, 3-bathroom, single story house. Fire extinguisher was mounted and charged. Smoke detectors are facility wide and tied to the sprinkler system. There was a locked area for medications and several for toxins and cleaning supplies. Beds were made with appropriate linens. Resident rooms contained the required furniture in 4 of 4 rooms. Hot water temperature was tested and found to be within regulation between 105 and 120 degrees F. Exit doors had working alert devices installed. Carbon monoxide detectors were present. This facility has submitted a request for a hospice waiver and a plan to care for residents with dementia. The plan has been reviewed and all physical plant safeguards have been checked. The applicant states that they do not plan to advertise at this time. A fire clearance for this facility has been granted. Component III orientation was conducted at facility. Applicant conveyed a good knowledge of Title 22 regulations. LPA received evidence of Liability insurance during visit. Facility is ready to be Licensed. LPA will submit the application packet for a final review and approval from the Licensing Program Manager.