Pre-licensing visit·June 15, 2021

Licensing Program Analyst (LPA) K. Hiratsuka, arrived at the facility announced on 06/15/2021 to conduct an announced prelicensing visit. LPA met with Facility Representatives Raghda and Nader Nassar, and explained the purpose of the visit. Mr. Nassar did have to leave during this visit and LPA finished the visit with Miss Nassar. 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 Raghda Nassar. This facility has a fire clearance for two ambulatory and four non-ambulatory residents. This facility has six private resident rooms. The main entrance has a ramp leading in. The front of this facility has two entrances; one with a ramp and one that does not. The main entrance opens to the main common area. The second door opens to a short hallway. The kitchen and dining area are located between the two doors. To the left of the main entrance there is a door leading to the four private non-ambulatory rooms, two full common bathrooms, exit to the outside, and laundry room. All four rooms have small patios. To the right of the main entrance is the kitchen and dining area and leads to a hallway that has the two ambulatory only resident rooms that have small patios, a full common bathroom, and office. All bathrooms have grab bars and nonskid mats. This facility shares a driveway with the building across the driveway. That building is separate address, but shares the lot.. The lot is surrounded by a fence that has a gate across the driveway and a pedestrian gate; however, the gates are not locked and shall remain unlocked at all times. Component III orientation was completed. This facility meets regulations. LPA is going to submit this report to the applications specialist.