Pre-licensing visit·September 30, 2021

Licensing Program Analyst (LPA) Kennedy conducted a Prelicensing/Component III visit to observe the physical plant for compliance. The LPA was met and granted entry into the facility by Helinita Penola, applicant. The LPA and Ms. Penola toured the physical plant and observed by the LPA were resident accommodations including furnishings, linens and personal hygiene items; resident bathrooms are equipped with non-skid flooring and paper towels, resident, staff and administrative records are to be located the locked medication closet;; food service including dishes, utensils, food storage and a seven day supply of nonperishables and a two day supply of fresh perishables are present; toxic substances are stored locked in a cabinet in the kitchen; medication storage and administration logs are located in locked closet first aid kit is locked in the medication closet; activities, supplies and sufficient space to conduct are present; smoke and carbon monoxide detectors are present and operable; facility posting are present in a common area and the facility administrator's certification is current; no pool or other body of water is present at the facility; per Ms. Penola, there are no guns, weapons or ammunition located on the property. Discussed with Ms. Penola were continuing operation requirements, record keeping and physical plant compliance. The following requirements need to be met prior to licensure: Water temperature needs to be within the required range; liability insurance needs to be acquired; a first aid manual needs to be acquired that meets requirements; non-discrimination policy needs to be posted; debris needs to be removed form the yard. Applicant will provide documentation of meeting these requirements to the LPA. An exit interview was conducted with Helinita Penola, Applicant. A copy of this report along with Licensee Rights (LIC9058 01/2016) was provided to Ms. Penola via email. An electronic response confirms the documents were received.