Pre-licensing visit·August 25, 2021

Licensing Program Analyst (LPA) Ruth Martinez conducted an announced visit to the facility for the purpose of a pre-licensing evaluation. LPA arrived was greeted and granted entry to the facility by Rona Lomeda, Director. An initial application to operate an Adult Residential Facility for the Elderly, age 60 years and over, for (122) capacity, (0) ambulatory, (122) non-ambulatory, and (0) bedridden clients was submitted to CCL on 03/23/2021. LPAs observed the following: Structure: Facility is a two story building with 64 apartment style resident bedrooms, dining room, and kitchen, front office, medication room, physical therapy room, doctor’s office, counseling room, activities room on first floor and a library, chapel on the second floor. There is a courtyard with seating for the residents. The resident bedrooms will accommodate residents' furnishings. Signal System: Central air/heating system installed with a central panel to control entire building. Bedrooms Residents: Bedrooms accommodate non-ambulatory residents only. There are 30 shared bedrooms on the first floor and 25 shared bedrooms, 3 private bedrooms, and 6 apartment style 2 bedrooms on the second floor. All bedrooms have half a bathroom. Continued on LIC809-C Bathrooms: All bathrooms have a working toilet, wash basin, and walk-in shower. Linens and Hygiene Supplies: Adequate supply of linens is stored in storage closet. Emergency Phone Numbers, Exit Plan, and Menu: Posted and readily available for review in the dining room. Food Service: Adequate supply of 7 day non-perishable and 2 day perishables will be stored in the kitchen with a storage room in kitchen for surplus goods. Smoke and Carbon Monoxide Detectors: Smoke and carbon monoxide alert systems are hardwired with a sprinkler system maintained by Electric Tech and A & A Fire Inc. Fire Extinguisher: Fully charged and mounted throughout the facility. Fire Clearance: Approved on 07/22/2021 . Appliances: Restaurant style kitchen with all appliances, washer and dryers in laundry unit are clean and noted to be operational. Toxins: Locked and stored in a storage closet. Continued on LIC809-C Water Temperature: Tested and recorded at 111.2-112.1 degrees Fahrenheit in bathroom on first and second floor. Medications, First Aid Kit & Manual: First Aid kit with guide is stored in medication room. Medication carts will be utilized for medication with locks. Resident and Staff Files: Records will be kept in medication room. Reading Material, Games, Equipment, & Materials: The facility has activities that commensurate with their plan of operation. Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance. Applicant was reminded that it is required to notify LPA, within 5 business days of admitting the first resident. This notification may be done by phone, email or fax. All items reviewed during the visit are in compliance. Facility appears to be ready for licensure. Accordingly, LPA will submit file for approval to CCL Supervisor. Exit interview was conducted and a copy of this report was left with the applicant.