Pre-licensing visit·July 3, 2025

At approximately 2:25 PM, Licensing Program Analyst (LPA) Julie Florio arrived announced to conduct a pre-licensing inspection and was greeted by Katherine Dizon, Designated Responsible Party (DRP). Kamilee G. Gantan, Administrator was contacted via telephone and gave permission to conduct today's inspection with DRP. Administrator arrived at approximately 3:00 PM. This pre-licensing inspection is being conducted for a change of ownership licensing of a Residential Care Facility for the Elderly (RCFE). Fire Clearance has been approved for 20 non-ambulatory and 4 bedridden resident. Administrator applied for a Hospice waiver for 9 which is being reviewed and has a dementia care plan. Licensee/Applicant works with a placement agency. There were 23 residents in care during today's inspection. At approximately 2:35 PM, LPA initiated a tour of the facility with DRP and observed the following: Facility is a one story building, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured above and below the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA advised DRP to correct the water temperatures and they agreed. LPA observed resident showers with the required non-slip mats and grab bars in place. LPA observed a supply of clean linens, hygiene products, incontinent care products, and paper products available for residents. Hallways are equipped with night lights and residents' bedrooms have all the appropriate furnishings as outlined in Title 22 regulations. There was a sufficient amount of dishes and cooking supplies for resident use with sharps and other hazardous items kept secured in various designated drawers and cabinets as well as under the kitchen sink. Continued on LIC809-C... ...continued from LIC809... Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked. Facility has at least two days of perishable foods, one week of non-perishable foods, and an emergency water supply. LPA observed a sample menu posted in the common area to indicate a healthy and balanced set of meals for residents in care. The facility telephone was tested and is operational. Facility has internet services and an internet access device designated for resident use. Facility has a designated locked centrally stored medication cart. LPA observed the facility's infection control plan, first aid kits, PPE, other emergency supplies, and a generator for emergency preparedness. LPA observed a posted activity schedule and supplies. The gated yard with patio was observed empty. Administrator states that new furniture it already ordered and will be delivered next week. Windows, screens, and blinds are all found to be in good repair. Facility has several fire extinguishers, which were last inspected 04/2025 and are fully charged. Administrator has posted hard copies of the emergency disaster plan and maps, personal rights information, local ombudsman information, and the CCLD reporting poster in facility communal areas. Staff are cleared and associated under the existing facility and Administrator agreed to associate the staff to the new facility license in Guardian. Licensee has been informed of association and staff transfer process. Medications were observed centrally stored and locked. Administrator states that Licensee submitted a copy of the facility's lease agreement and liability insurance to the Centralized Application Bureau. LPA observed a facility sketch which accurately reflects the floor plan. Component III orientation was conducted with the Administrator at facility where they conveyed knowledge and understanding of Title 22 regulations. The pre-licensing evaluation has been completed. Exit interview conducted with Administrator, whose signature on this document confirms receipt .