Pre-licensing visit·June 24, 2021

Licensing Program Analyst (LPA) K. Hiratsuka, arrived at the facility announced on 06/24/2021 to conduct an announced prelicensing visit LPA met with Facility Representative Andrew Makanoneng 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 Facility Representative 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 Andrew Makanoneng . This facility has a fire clearance for seven non-ambulatory residents. This facility has seven private resident rooms and all but one room has an exit to the outside. The main entrance opens to a sitting area on both sides and there is an office set-up on the right. Across the main entrance is the only hallway that has the kitchen and dining on the left, a full common bathroom on both sides, two resident rooms on the left, and five resident rooms on the right. Two of the resident rooms on the right have private half bathrooms. The hallway leads to another common area in the back. This facility has a second floor that has one room and a full private bathroom and is not accessible to residents. The garage is connected to the facility by a door on the right sitting area.. The garage is used for storage. There are also two rooms in the garage that are not to be used for sleeping quarters for staff. The two rooms may be used as break rooms or storage. The backyard was inspected. There are gates on both sides of the facility. There are three locked sheds on right of the facility. There are gates on both sides of the facility. The exit to the backyard exits to a wood patio that is well maintained. There is a little sitting area in front of the main entrance. Component III orientation was conducted during this visit Multiple topics were discussed during this visit. This facility meets regulations. LPA is going to submit this report to the applications specialist.