Pre-licensing visit·May 7, 2020

Licensing Program Analysts (LPA) Jenifer Tirre and Kimberly Lyman contacted the facility via telephone to conduct a pre-licensing visit via FaceTime due to COVID-19 and pre-cautionary measures. LPA's identified themselves and discussed the purpose of the call with Licensee/Administrator Maria Emeterio. Administrator Jeremy Parungao was present as well. An initial application to operate a Residential Facility for the Elderly was received by CCL on 04/17/2020 for a capacity of 5 non-ambulatory residents and 1 bedridden resident. There are 0 residents in care during today's visit. LPA Tirre, and LPA Lyman along with Administrators Emeterio and Parungao toured the facility via FaceTime at 10:07 AM and observed the following: Structure: Facility is a one story, 5 bedroom, 2 bathroom house with an attached garage and a peach exterior. The exit gates are closed unlocked, and self latching. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: 4 of 5 rooms are equipped with appropriate lighting, dresser, and ample closet space. All exit doors are equipped with operational auditory exit alarms. Bathrooms: All resident bathrooms have a working toilet, wash basin, and bathtub/shower as well as grab bars and non-skid surface in the shower. Linens & Hygiene Supplies: Linen supply is in ample supply for residents in care. Emergency Phone Numbers and Exit Plan: Available for review in common area of the facility. Food Service: Facility to obtain 2 day perishables as well as 7 day non-perishables in the pantry/ refrigerator, prior to admitting residents. Smoke Detectors: Smoke detectors/ carbon monoxide detector are centrally wired and were tested operational. Fire extinguishers are mounted and charged. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins : Locked/stored in secured cabinet inside garage. Water Temperature: Tested and recorded between 108.2 and 109.9 degrees F. in facility bathrooms. Reading Material Games, and Equipment: LPA's observed games, puzzles and coloring books. Due to COVID-19, there are no group activities scheduled at this time. CONT ON LIC 809C DATED 05/07/2020. Medications, First-Aid Kit & Book: First aid kit observed contained most of required items including tweezers and scissors. LPA's observed completed emergency disaster plan. Medication is stored and locked in the facility. Kitchen shar ps also locked inside Medication cabinet. Backyard: LPA observed a clean safe backyard with ample shaded seating. Fire Clearance: Approved for 5 non-ambulatory residents and 1 bedridden resident on 04/16/2020. The facility is ready to be licensed. Component III was waived due to Licensee operating multiple facilities. Licensee to correct the following items: Let us know poster needs to be proper size of 20x22, proper posters in restrooms for hand washing procedures, and entry posters outside upon admitting residents. Private room #2 needs dresser First-Aid Kit needs First-Aid manual and thermometer. Licensee to obtain emergency food and water supply upon admission of residents. An exit interview was conducted with Administrator Emeterio via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.