Pre-licensing visit·September 6, 2024

Licensing Program Analyst (LPA) Rose Ruppert made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA met with Licensee (LE) Jennifer Ghahyasi. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by our agency on March 18, 2024 for a total capacity of six; six non ambulatory and one bedridden in room one. The facility is approved for six residents on hospice. The facility is a one story home with six private resident rooms, two bathrooms, a living room, a kitchen, a dining area, and an attached two car garage. There is a backyard exit gate on the side of the house that is self-latching and unlocked. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard. LPA observed the See Something, Say Something poster (PUB 475), Personal Rights, and Emergency Disaster Plan, Menu and Administrator's Certificate on kitchen bulletin board.. Two of six resident bedrooms had the required furnishings. LPA observed two beds with linens in rooms five and six. All toxic chemicals, cleaning solutions, and disinfectants are inaccessible to residents and will be stored and locked in secured hall closet with a locked medication cart. The first aid kit is mounted in kitchen and has all the required elements. Reading materials and games were observed in the living room with a phone for resident use. A supply of two-day and seven-day of non-perishable food was observed and will be maintained on hand. Smoke detectors and carbon monoxide detectors tested operational. Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. LPA will return on Thursday, September 12, 2024 at 1pm. Licensee will provide a bed in four resident rooms, fireplace screens for two fireplaces and will adjust hot water temperature to be within 105-120 degrees Fahrenheit for both bathrooms. Licensee also purchased a First Aid Manual for the facility. Licensee has waived the Component III since LE currently operates two facilities. Administrator's certificate expires on August 15, 2025. An exit interview was conducted and a copy of this report was provided to Licensee.