Pre-licensing visit·November 16, 2021

Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 11/16/2021 to conduct a Prelicensing inspection. LPA met with Licensee and Administrator, Magdalena Saeger and Garbriel Bercea, and explained the purpose of the visit. Prior to initiating the Prelicensing inspection, 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 and contacted licensee 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 were screened by facility staff upon entering the facility. LPA was allowed entry into the facility that will be licensed for a capacity of six (6). LPA toured the interior and exterior of the facility with Licensee and Administrator. The indoor and outdoor passageways were free of obstruction. Upon entering the facility LPA observed COVID-19 signages. Areas toured include but are not limited to: common areas, six (6) resident bedrooms, two (2) bathrooms, kitchen, garage, medication room, and backyard. LPA observed knives/sharps were locked in the kitchen by sink. LPA observed the require furniture, and lighting throughout the facility. Bathrooms are clean, sanitary, and in good repair. Hot water temperature was measured in residents' bathroom at 102 degrees Fahrenheit. First aid kit was completed with bandages, tweezers, scissors, and thermometer located in the medication room. LPA observed one (1) fire extinguisher in the kitchen. Licensee and Administrator stated the facility has a fire sprinkler system set up at the facility as well. LPA observed fire detectors and carbon monoxide. Component III presentation conducted with Licensee and Administrator. LPA observed that the facility is ready to be licensed. This report will be submitted to the Centralized Application Bureau (CAB) and final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. An exit interview was conducted with Licensee and this report will be provided to the facility via email.