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. This facility is undergoing a change-of-ownership. LPA met with Facility Representatives Russelle and Curtis Robinson, and Arminder Tahkar 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 Curtis Robinson. This facility has a fire clearance for six non-ambulatory of which one may be bedridden. This facility has six private resident rooms and two caregiver rooms. The main entrance opens into a small foyer. To the left of the main entrance there is a small office area and kitchen. Past the kitchen and office area there is a door leading to a hallway that has the laundry area, door leading to the garage and one caregiver room, a caregiver room, a full common bathroom, and two resident rooms that have exits to the outside. To the right of the main entrance is another door that leads to a hallway that has four private resident rooms and a full common bathroom. Across the main entrance is the main sitting area, dining area, and kitchen. There are locked cabinets for sharp knives and medications. The backyard was inspected. There is a gate on the same side as the garage. There is a raised wood patio that is has one area covered and the patio has ramps. There is a pool with a five foot tall wrought iron fence surrounding it and is locked. LPA waived the component III orientation because Facility Representatives 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.