Pre-licensing visit·May 24, 2023

Licensing Program Analyst (LPA) Avelina Martinez arrived announced to conducted a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA Avelina Martinez met with Yelena Bigelow who assisted LPA Martinez in today’s inspection. Facility has a fire clearance for 1 ambulatory resident and 5 non-ambulatory residents. Bedrooms 1, 2, and 3 are permitted for non-ambulatory resident use only. In addition, bedroom 6 is only permitted for ambulatory resident use only. Moreover, rooms 4 and 5 are not permitted for staff or resident use. Rooms 4 and 5 are only permitted for storage use. Yelena Bigelow, will be the Administrator of this facility. The facility administrator’s certificate is current, and it expires on February 01, 2025. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA toured the facility with Yelena Bigelow on May 24, 2023. LPA reviewed the facility sketch, and it needs to be revised to reflect the approved fire clearance STD 850 document. The facility sketch reflects storage rooms 4 and 5 as bedrooms, which they are not permitted as bedrooms. Furthermore, at today's visit LPA Martinez observed a staff occupying room 6, and their belongings were stored in the room. LPA Martinez will return to facility to complete the pre-licensing visit once staff has vacated resident bedroom #6 or reduce resident capacity to 5 and designate room 6 as a staff room. The applicant has not passed the pre-licensing component of the application process. The applicant will correct outstanding issues, and inform LPA Martinez when the corrections have been completed. An exit interview was conducted, and a copy of this report was provided to the applicant.