Pre-licensing visit·June 30, 2025

On 06/30/2025 at 12:45 pm Licensing Program Analyst (LPA) Beena Singh conducted an announced visit to the facility for the purpose of a Pre-Licensing evaluation. LPA Singh met with Administrator Mehrunnisa Latif . An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 03/25/2025 for a total capacity of six (6) four(4) non-ambulatory and two(2) bedridden residents. Waiver granted for six(6) Hospice care residents on 06/11/2025. Fire clearance was granted on 04/08/2025. LPA observed the following: Structure : The facility is a one(1) storey house with four (4) bedrooms two (2)resident bathrooms, living room, dining area and kitchen. There was an attached three car garage on the left side of the house. Heating /Cooling System: Central heating and air conditioning system installed with a control panel located at the back of the facility. Bedrooms: Bedrooms 2,3,4 will accommodate non-ambulatory residents and bedroom one (1) will accommodate bedridden residents are adequately furnished with bed, closet, appropriate linens and adequate lighting. Night lights were observed in the facility and will be placed in the hallways leading to residents' shared bathrooms. Bathrooms : There is a staff bedroom with bathroom and there are two (2) bathrooms for the residents which have working toilets, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. The water temperature was measured at 110 degrees Fahrenheit in the resident’s bathroom. Kitchen: The kitchen has an adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives and knives were secured in a locked drawer located in the kitchen. There was an adequate room for food storage. LPA observed the stove to be operational. Refrigerator(s)/freezer(s) were in working condition. There was sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry: Laundry room with washer and dryer. Laundry detergents and cleaning supplies will be locked in the laundry room, which can be locked from exterior door. Living /Family Room: There was a living/family room with a TV and adequate seating for all residents. Linens and Hygiene: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outdoors: There is sufficient covered seating area the backyard. The gate on the right side is the exit and is self-latching. All outdoor pathways were free of obstructions. Emergency Phone Numbers and Exit Plan : Facility sketches were observed posted in the main living room area. There were two(2) fire extinguishers and two(2) carbon monoxide detectors and five(5) smoke detectors which are working and in good condition. General items: Client records will be stored in a locked cabinet.. First Aid kit with required components is located in the dining room cabinet. Personnel files and medication will be locked in the cabinet. LPA observed a facility phone- 909-320-7320 and it was verified to be operational. Emergency water supply and food were observed. The facility has met the requirements according to Title 22 regulations and is ready for licensor. An exit interview was conducted, no deficiencies were cited, Component III was completed during this visit, and a copy of this report was reviewed and provided to Administrator Mehrunnisa Latif.