Pre-licensing visit·July 12, 2021

Licensing Program Analyst (LPA) K. Hiratsuka, arrived at the facility announced on 07/12/2021 to conduct an announced prelicensing visit. This facility is undergoing a change-of-ownership. LPA met with Facility Representatives ILona and Alex Timofey 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 Alex Timofey. This facility has a fire clearance for all non-ambulatory. The front entrance opens to a small foyer. To the immediate left is a private resident room and to the immediate right is a private resident room. Across the main entrance is one of two common areas and to the right of the sitting area is the kitchen. Behind the kitchen is a doorway that leads to an office, a door leading to the garage, and a second door leading to the caregiver room that has a full private bathroom. To the left of the entrance and past the resident room is a hallway that leads to three private resident rooms and one full common bathroom. The private resident room at the end of the hallway past the bathroom has an exit to the outside that leads to a private wood deck and a full private bathroom. In the back left corner of the first common area is a second common area with the sixth private resident room. Backyard was inspected. There is a wood deck that leads to the gate that is next to the garage. There is a locked shed on the side opposite the garage. Component III orientation was conducted.. This facility meets regulations. LPA is going to submit this report to the applications specialist.