Pre-licensing visit·December 16, 2024

Licensing Program Analyst's (LPA's) Jenifer Tirre and Eboni Bentley visited this facility for the purpose of conducting a Pre-Licensing evaluation. Facility is a two story residential home. LPA's along with Administrator Kaytee Lumauig toured facility at 2:45PM and observed the following: Fire clearance approval was received on 10/03/2024. Structure: Facility is a two story, 9 bedroom home. 6 Resident rooms located on first floor and three bedrooms located on second floor for licensee live in staff. Facility has three full and one half bathroom. Facility has attached garage. 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 shower as well as non-skid mats 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. Facility has two fire extinguishers. Fire extinguisher's are mounted and charged. Facility has audible alarms on all sliding/exit doors. Appliances: Electric Stove and refrigerator are operational. Toxins : LPA's observed cleaning supplies and toxins secured in laundry storage area as well as under kitchen sink.. Water Temperature: Tested and recorded between 111.7 to 116.4 degrees Fahrenheit in facility bathrooms. Reading Material Games, and Equipment: facility does exercises, puzzles and games. Facility has a tablet with internet for Resident use. Medications, First-Aid Kit & Book: Facility has first aid kit present at the facility with first aid manual. Facility has a secured location for medications and facility files. Facility has department postings in entry way. CONTINUED 809C . Backyard: LPA observed the facility perimeter is secured by wall with gates on both sides of facility as required. LPA observed shaded outdoor seating. Facility has a pool with secured gate. Administrator's Certificate observed for Kaytee Anne Lumauig expiring November 30, 2026 Component III Orientation was not completed during this pre-licensing visit and will be completed at follow up visit. Licensee to address the following corrections by January 6, 2024: · Licensee to remove expired canned goods and condiments from kitchen pantry & fridge · Licensee to provide grab bars on side of restroom toilets ( restroom 1 and restroom 2) · cleaning supplies to be secured in upstairs staff common area · Licensee to provide additional emergency food for all residents and staff · outside gates need repair of springs to have gates latch on both sides of house · outside patio area needs upkeep near fruit trees · Facility capacity needs to be corrected from 9 to 6 The facility is not ready to be licensed. Licensee to contact LPA when corrections are complete. An exit interview was conducted with Administrator Lumauig and a copy of this report was left at the facility.