Pre-licensing visit·August 24, 2022

Licensing Program Analyst (LPA) Jesse Gardner conducted an announced pre-licensing inspection to the facility to complete the pre-licensing inspection and Comp III. LPA arrived at the facility and was met with Administrator Mirafe Deramas. Administrator Deramas accompanied LPA on a tour of the inside and outside of the facility. This is a change of ownership Pre-Licensing inspection; thus 5 residents were currently in care. The facility is a four bedroom, two bathroom home. The facility has a living room, dining room/kitchen. Per the approved fire clearance, the licensee is approved for 5 non-ambulatory residents, and 1 bedridden resident. All bedrooms are furnished with bed, night stand, dressers and have adequate lighting for residents use. The facility currently has linens, towels and a sufficient amount of hygiene products for residents. The bathrooms have grab bars and non-skid mats installed. The water temperature was tested and measured between 111.8 to 115.0 degrees Fahrenheit. The smoke alarms and carbon monoxide alarm were tested and are in operating order. LPA observed one fully charged fire extinguisher which was present in the dining area. The kitchen was observed to have dishes, silverware and pots and pans. The knives were stored in a locked drawer in the kitchen. The medications, will be stored in a locked cabinet in the kitchen. The chemicals will be stored in a locked room outside. The backyard was observed to provide access to residents via a driveway, and also was observed to provide plenty of shade via a covered patio and covered outside area. LPA found all facility features to be in compliance and in line with Title 22 Regulations. An exit interview was conducted and a copy of this report was reviewed with and provided to Administrator Mirafe Deramas.