Routine inspection·December 14, 2021

Licensing Program Analysts (LPAs) Ruth Martinez and Kevin Saborit-Guasch is conducting this unannounced visit for the purpose of completing an annual inspection. LPAs arrived at facility was greeted and granted entry by Administrator. During today’s visit LPAs met with Luming Gustave, Administrator and explained the nature if the visit. LPAs toured the facility and inspected the physical plant, no residents were observed at the facility. LPA was informed that there are no residents currently residing at the facility and only occupant is Administrators. LPA was informed that facility last had residents in January of 2019 and resident was moved to one of their other facilities since. Licensee will contact Community Care Licensing (CCL) to inform of when they are ready to accept new residents of if there are any changes with the license. LPA was informed that Administrator just paid the annual fee for the license. The facility has completed the LIC808 Mitigation Plan, the plan was approved by the Department on March 05, 2021. At this time there were no deficiencies to report in the facility. As noted above, Licensee will contact CCLD once residents are being admitted. In an effort to update the facility file, the Administrator is required to submit to the licensing agency a copy of the following: - An updated Personnel Report (LIC 500). - Copy of Administrator Certificate. This report was reviewed with administrator and a copy of this LIC809 report was provided.