Pre-licensing visit·March 7, 2024

On March 07, 2024 at 2:20 PM, Licensing Program Analyst (LPA) Avelina Martinez arrived unannounced to conducted a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA Avelina Martinez met with Penina Tuimaualuga 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, 3, and 6 are permitted for non-ambulatory resident use. Moreover, rooms 4 is not permitted for staff or resident use, and it is only permitted for storage. Rooms 5 is only permitted for staff 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 Penina Tuimaualuga on March 07, 2024. During today's pre-licensing visit, LPA Martinez observed the following items to be in good repair and in compliance : Facility door locks and knobs Wheelchair Ramps Patio tiles Cleanliness of facility Food supply Emergency exit gate/free of debris. Resident files-LIC 602 and Needs and Service Plans- Fire Clearance (no bedridden residents) The applicant has passed the pre-licensing component of the application process. LPA Martinez will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. Component 3 waived due to previous review of component 3. An exit Interview was conducted, and a copy of this report was provided to the facility.