Facility-requested visit·October 10, 2024

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced case management visit to change the ambulatory status of the facility. LPA met with Assistant Administrator Amyrose Undag and explained the purpose of the visit. At the time of visit there were five (5) residents. Licensee requested a change in the facility's ambulatory status from six (6) non-ambulatory residents to five (5) non-ambulatory status and one (1) bedridden. The facility capacity has not changed. A Fire Clearance was approved on 07/31/24 for a room addition for the one (1) bedridden resident, no change in capacity. Facility sketch on file shows sufficient square footage in the facility and activity rooms to accommodate the ambulatory status change with Bedroom Four having a sliding door exit/entrance approved by the fire department. LPA toured the interior/exterior of the building and visually inspected the resident bedrooms. LPA confirmed that all identified shared rooms are large enough to accommodate the required furniture for two residents without inhibiting movement into and throughout the rooms. The facility has four (4) bedrooms and two (2) bathrooms for the residents. The facility has 1 additional bedroom and bathroom for staff. The physical plant is ready for change in ambulatory status. LPA will submit file for approval. The final approval of capacity increase is contingent upon LPM's final file review. Licensee will be notified by LPA once capacity increase has been approved by licensing. If ambulatory status is approved, new license will follow in the mail after phone notification by LPA with Licensee. An exit interview was conducted where this report was discussed with and a copy was provided to Assistant Administrator Amyrose Undag