Pre-licensing visit·May 18, 2023

Licensing Program Analyst (LPA) Cassie Yang arrived announced and met with Applicant, David Deluca. LPA explained the purpose of the visit is to conduct Pre-licensing inspection. LPA wore the following Personal Protective Equipment: surgical mask. LPA observed six (6) residents to be present in their rooms. Currently one (1) resident on hospice services. This application is a change in ownership. Facility has a clearance for five (5) non-ambulatory and one (1) bedridden. LPA and Deluca toured the interior and exterior of the facility. Areas included but not limited to: common areas, kitchen, resident bedroom, bathrooms, staff room and backyard. LPA was informed that residents are in bed, taking a nap before brunch. LPA observed the facility to have adequate food supplies, 7+ days of non perishables and 2+ days of perishables. LPA observed hot tap water to be at 111*, LPA observed the temperature of the facility to be 71* During today's inspection, LPA observed the fire extinguisher to be serviced 3/3/2023, and facility's carbon monoxide and smoke alarms to be operable. LPA observed a new First Aid kit, PPE supplies and linens. LPA was provided proof of pest extermination, last serviced 5/11/2023. LPA discussed resident paperwork to be completed upon ownership change. LPA observed various required postings. LPA observed Theft & Loss Policy, blank admission agreement and visitation policy is posted in facility public binder. Component III was waived during today’s inspection as Deluca was recently Administrator certified and a previous licensee. LPA will notify the applications unit the facility is in substantial compliance. Exit interview conducted and a copy of report left at the facility.