Pre-licensing visit·June 3, 2021

Licensing Program Analyst (LPA) K. Hiratsuka, arrived at the facility announced on 06/03/2021 to conduct an announced prelicensing visit. LPA met with Applicant/Administrator Daisyree Tacandong, and explained the purpose of the visit. Prior to initiating the prelicensing visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted applicant and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by Administrator at the front door. This facility has a fire clearance for all non-ambulatory. The main entrance opens to a small foyer. To the right of the main entrance is a short hallway that has two private resident rooms and a full bathroom. Past the first hallway on the right is a third private resident room, locked door to the laundry room, and a small office nook. To the left of the main entrance is a door leading to the garage, and a forth private room that has a locked door leading to the kitchen. Across the main entrance is a double-door that leads to the main common area and the fifth resident room which is shared. The shared resident room is on the right, has an exit to the outside, and a full private bathroom. There is also a second door leading to the laundry room. There are locked cabinets for medications and sharp knives in the kitchen. The backyard was inspected. There is a covered patio, and a fire place. The fire place is disabled. The gate is on the same as the garage. LPA waived the component III orientation because Administrator already operates another facility. Multiple topics were discussed during this visit. This facility meets regulations. LPA is going to submit this report to the applications specialist.