Pre-licensing visit·April 1, 2022

Licensing Program Analysts (LPAs) Michael Hood and Talwinder Bains met with applicant, Carmen Ion, to conduct a Pre- Licensing visit. This application is a change in ownership. This address is currently licensed as Carmen Elderly Care Facility #: 347005703. The facility has a fire clearance for five (5) non-ambulatory residents . Applicant holds a current administrator certificate (#6034379740 with expiration date 03/16/2023). LPAs conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are three (3) bedrooms and two (2) bathrooms for resident use. LPAs observed facility to be properly furnished, including appropriate bedding and lighting in bedrooms. Bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 112 degrees F. LPAs checked the kitchen area for the ability to prepare and store food. Knives and sharp objects found to be inaccessible for residents during visit. LPAs observed at least a 2-day perishable and 7-day nonperishable food supply at the facility. LPAs observed cleaning products and other toxins to be locked away. LPAs observed the area used for medication to be locked and inaccessible to residents. LPAs observed smoke detectors and carbon monoxide detectors at the care home are operational. Fire extinguishers are ready for emergency use. LPAs reviewed two (2) residents file and two (2) staff files. Component III was completed. Application is pending and LPAs will forward findings to the Centralized Application Bureau (CAB) for final review and approval. CAB will further contact applicant on final status of application. A copy of this report was provided to the facility. Exit interview conducted.