Pre-licensing visit·October 29, 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 Administrator Marie Joyce Maniago. An initial application for a license to operate as a Residential Care Facility for the Elderly was received by the Department on June 2, 2025 for a capacity of five non-ambulatory and one bedridden 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 six private bedrooms. 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 two bathrooms on the premises. Water temperature was measured to be within acceptable range at 120F in three separate locations throughout the facility. Common living spaces are present and a device connected to the internet is present for the use of the residents in care. 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 where emergency supplies are also stored. 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. Room #1 is identified as the room cleared for a bedridden resident. Combined smoke and carbon monoxide detectors are observed throughout the facility and confirmed to be functional. Two wall-mounted fire extinguishers present on the premises are confirmed to have been obtained in April 2025. First aid kit verified to be complete. There is a fireplace in the living room which has been disconnected from the natural gas supply and will not be put in operation. Fireplace however requires a screen which is currently absent. LPA and licensee toured the outside of the facility and observed it to be free of obstructions. Multiple shaded areas are present in the back of the house and are equipped with outdoor furniture for the enjoyment of residents and visitors. There are perimeter gates present on both sides of the house. The gate on the north side of the house does not self-latch due to a slight overlap with the door frame and will require an adjustment. 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 two 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.