Pre-licensing visit·September 13, 2022

Licensing Program Analysts (LPAs), Kathrina Chin and Jessica Cho made an announced visit for a pre-licensing evaluation. LPAs met with Janella Cervania, Applicant and Karmian Calangi, Applicant/Administrator. The facility has four bedrooms and two full bathrooms and one half bath. This is a single story with a two car garage facility. The inspection is as follows: A fire clearance was granted on August 23, 2022 for 5 non-ambulatory and 1 bedridden. The facility is requesting for a hospice waiver for 4 residents. LPAs toured the facility, interior and exterior, including all resident bedrooms. The hot water temperature was tested in the resident bathrooms and observed to be 79.8 degrees Fahrenheit. One fire extinguisher was mounted and charged. Smoke detectors were centrally wired throughout and have been checked by the fire department. Carbon monoxide detectors are operational. There is sufficient supply of linens. There are non-skid mats in the showers. There was one locked medication closet and one first aid kit. There were several locked closets for storage of toxins and cleaning equipments. All exits have auditory devices. The kitchen area was checked. Karmian Calangi stated that she will post activity calendars, theft and loss policy, residents rights, admission agreement, and emergency plans. The facility needs to post an Ombudsman and Let Us Know posters. LPA reviewed the outdoor area and there were outdoor furniture but no umbrella for shade. (Continued LIC 9099C) A second pre-licensing will be scheduled. The following items need to be corrected prior to licensure: 1) Air conditioning is broken. Karmian Calangi stated that she will have an air conditioning installed. 2) A fire protective screen for the fire place is needed. 3) The facility needs to post an Ombudsman and Let Us Know posters. 4) The facility needs to post activity calendars, theft and loss policy, residents rights, admission agreement, and emergency plans. 5) The facility does not have hot water. The hot water temperature was measured at 79.8 degrees Fahrenheit in all three bathrooms. 6) The facility does not have a COVID-19 screening station. 7) The facility does not have 30 day PPE supplies 8) A tweezer for the first aid kit and first aid manual are needed. 9) A patio umbrella is needed for shade. 10) Post hand washing signs in all bathrooms. 11) Remove all debris by the exit and side gate 12) Mattress pads and blankets are needed for the six beds. 13) Cover up the two holes on the bedframes. 14) Remove all trash and debris in the garage. 15) Please associate Karmian Calangi, Administrator to the facility. A Component III was completed during the visit with Janella Cervania and Karmian Calangi, Applicants. LPAs reviewed Personnel Policies, Prohibited Health Conditions, Fingerprinting, Abuse Reporting Procedures, In-Service Training, and Medication Procedures. It appears that this facility does not meet the requirements for licensure. A second pre-licensing visit will be scheduled. An exit interview was conducted with Janella Cervania and Karmian Calangi, Applicants and a hard copy of this report was provided.