Pre-licensing visit·April 9, 2021

Licensing Program Analyst (LPA) Jenifer Tirre contacted the facility via telephone to conduct a subsequent pre-licensing visit via Face Time due to COVID-19 and pre-cautionary measures. LPA identified themselves and discussed the purpose of the call with Administrator Yaninee Asawadilokchai. An initial application to operate a Residential Facility for the Elderly was received by CCL on 12/08/2020 for a capacity of 6 non-ambulatory residents. Pre-licensing is for initial licensure. There are 0 residents in care during today's visit. LPA and Administrator toured the facility via Face Time and observed the following: Licensee had required postings posted near the entry of facility Licensee has emergency food and water supply Licensee has first aid kit with first aid manual Licensee has sharps secured in a locked storage Licensee has thermometer to check water temperature. Water temperature was tested and recorded at 113.5 degrees to 114.0 degrees Fahrenheit Licensee has shaded outdoor seating for residents Licensee has placed Non-skid mats inside showers/tubs Licensee has grab bars in every restroom Licensee has dresser and chairs for each resident in resident rooms Licensee repaired gate latch for fence to properly close/open CONTINUED ON 809-C CONTINUED FROM 809 Licensee has working telephone for residents to use Licensee/Administrator has completed the noted corrections and is ready to be licensed. An exit interview was conducted with Administrator Asawadilokchai via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.