Pre-licensing visit·May 30, 2024

Licensing Program Analyst (LPA) Jenifer Tirre visited this facility for the purpose of conducting a Pre-Licensing evaluation. Facility is a single story residential home. LPA along with Administrator/Licensee Vijay Kanase toured facility at 9:00AM and observed the following: Fire clearance approval was received on 01/30/24. Structure: Facility is a one story, 5 bedroom (4 Residents bedrooms and 1 live in staff bedroom) 3 bathroom house with attached garage and a white exterior. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: All Residents bedrooms meet Licensing requirements. 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: Facility has adequate supply of linens and towels. Emergency Phone Numbers and Exit Plan: Facility has Emergency Plan posted on wall. Food Service: Facility has 2 day perishables as well as 7 day non-perishables in the pantry/ refrigerator, as well as emergency food and water supply. Smoke Detectors: Smoke detectors/ carbon monoxide detector are centrally wired and were tested operational. Fire extinguishers are mounted and fully charged. Facility has 2 extinguishers. Facility has audible alarms on all sliding/exit doors. Appliances: Gas Stove, microwave and refrigerator are operational. Toxins : LPA observed toxins secured in laundry storage area.. Water Temperature: Tested and recorded between 119.8 to 123.0 degrees F. in facility bathrooms. Reading Material Games, and Equipment: facility has puzzles, games, and books. Medications, First-Aid Kit & Book: Facility has first aid kit present at the facility. Facility has a secured location for medications and facility files. Backyard: LPA observed the facility perimeter is secured by wall with gate on both sides of facility as required. LPA observed shaded outdoor seating. Administrator's Certificate observed for Myrna Ebreo expiring July 15, 2025 and Vijay Kanase expiring May 1, 2025. CONTINUED ON 809C Component III Orientation was waived during this pre-licensing visit due to Administrator presently operating other facilities. Licensee to address the following corrections by 06/10//2024: Garage door to have secure locked door knob upon entrance Facility to obtain Proper approved First Aid Handbook (Licensee ordered and provided proof of delivery next day) Facility has secured gates on both sides of house but gates need to be self latching per regulations. Outside passageway on right side of house has a plumbing drain that has overflow of water from kitchen area, area is a potential fall risk hazard. Facility to repair drain to no longer have overflow Resident Room 3 needs hole in wall patched & repaired At this time facility is not ready to be licensed. Licensee to contact LPA when corrections are complete. An exit interview was conducted with Licensee and a copy of this report was left at the facility.