Pre-licensing visit·March 11, 2026

On 03/11/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived announced to this facility to conduct a pre-licensing visit. LPA met with applicant, Josepina Sipin and explained the purpose of the visit. The purpose of this visit was to conduct a Pre-Licensing Visit. This facility will hold 6 residents, of which 5 may be non-ambulatory and 1 may be bedridden in bedroom #3. This facility also has a dementia plan on file with a hospice waiver for 4 residents. Current census was 0. A brief interview with applicant Sipin was conducted. The perspective facility administrator has an active administrator certificate #6073769740 and expires on 12/19/2026. A tour of the facility was conducted. A tour of the kitchen was conducted. LPA observed a sufficient amount of 2-day perishable and 7 day non-perishable food supply. LPA observed knives and toxins locked and made inaccessible to residents in care. A medication cabinet was identified in the cabinet in the kitchen. A fire extinguisher was also located in the kitchen and was serviced by Jorgensen Co on 08/27/2025. A tour of the back yard was conducted with no hazards present. Perimeter fence and exit gates were observed to be in good repair. A tour of the living area, dining area, and other areas intended for resident use was conducted. Furniture was observed to be in good repair and meet resident needs. A tour of 2 bathrooms were conducted. Hot water was taken to ensure compliance within regulation. Grab bars were present and in good repair. A tour a 4 resident bedrooms were conducted. Resident furniture was observed to be in good repair and meet residents needs. An additional staff bedroom was toured. A tour of the laundry room was conducted. Toxins and other cleaning supplies were identified and made inaccessible to residents in care. A linen closet was identified and presented a sufficient amount of linens to meet the needs of the residents. A tour of the garage was conducted where additional supplies will be held. Emergency lighting was present throughout the home. Carbon monoxide and smoke alarms were observed and tested to ensure it was in proper working condition. Based on the observations made during this visit, this applicant has passed the pre-licensing inspection. Component III was reviewed with this applicant. An exit interview was conducted and a copy of this report was provided to the applicant at the end of this visit.