Pre-licensing visit·December 18, 2025

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made a scheduled visit to the facility for the purpose of conducting a pre-licensing inspection. LPA was greeted and granted entry by Executive Director Jozef Springer and Administrator Michelle Nesbitt. An initial application for a license to operate as a Residential Care Facility for the Elderly was received by the Department on March 4, 2025 for a capacity of six non-ambulatory residents. This is the first license to operate a residential care facility for the elderly at this address. There are no residents currently in care. LPA accompanied by administrator toured the physical plant. The facility is a one-level home with a frontyard, backyard and attached garage. There are seven private bedrooms, one of each will be used for overnight staff. Each of the bedrooms include all necessary components of furnishing including a light, chair, storage space for personal items and a full-size bed as well as a supply of linen, bedsheets and towels. There are three bathrooms on the premises. Water temperature was measured to be within acceptable range at 114F and 118F in two separate locations throughout the facility. Common living spaces are present. Facility is clean, sanitary and free of odors in all areas inspected. Required posted documents are observed to be present. Kitchen equipment is present and operating as required. Sharp items and cleaning supplies are confirmed to be secured. A sufficient supply of perishable and non-perishable food is present as required by Title 22 Regulations. The centrally stored medication storage is located in a secure closet. The garage is used for additional storage. Emergency lighting, night lights, first aid kit and additional supplies are present. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Prospective licensee is requesting a hospice waiver for six residents along with the license. The fire clearance has been obtained and provided to the Department before the pre-licensing visit. Combined smoke and carbon monoxide detectors are observed throughout the facility and confirmed to be functional. One wall-mounted fire extinguisher is present on the premises. There are no fireplaces on the premises. LPA and applicant toured the outside of the facility and observed it to be free of obstructions. One large shaded area is present in the back of the house and is equipped with outdoor furniture for the enjoyment of residents and visitors. There are self-latching perimeter gates present on both sides of the house. There are no bodies of water on the premises. Licensee is not cleared for and does not plan to use delayed egress or locked perimeters. Component III was waived as the prospective licensee already operates multiple licensed facilities as the current facility administrator. This report was reviewed with facility representative and a copy of this report was emailed to the prospective licensee before the conclusion of the visit.