Pre-licensing visit·July 11, 2022

Licensing Program Analyst (LPA) Janira Arreola, made an announced visit to the facility for the purpose of a pre-licensing inspection for a change in ownership. LPA was greeted and granted entry by Aleksandar Boskoski. At the time of the visit there were 6 residents and 3 staff members present. LPA walked through the facilities interior and exterior. LPA observed the facility to be a single story home with 7 bedrooms and 3 bathrooms. 6 bedrooms are designated for residents and 1 room is for staff. LPA observed required furniture such as bed, lights, chair, and closet space in all 6 bedrooms. LPA observed bathrooms to have required hygiene supplies for residents, with grab bards, non-slip mats, and paper towels and toilet paper. Hot water temperature was recorded at 105.4F. The hallways had night lights, and the fire and Carbon Monoxide alarms were observed to be in working condition. In the kitchen LPA observed a sufficient 2-day of perishable and 7-day supply of non-perishable foods. There were sufficient pots, pans, plates, cups, and eating utensils for 6 residents. The sharp objects were being kept in a locked cabinet. LPA observed the dinning area and outdoor seating area to have 6 chairs and outdoor area to have shade. The garage was kept locked with laundry room inside with the needed cleaning supplies for laundry and locked cabinet for cleaning and disinfecting at the facility. LPA reviewed facility plan of operation, emergency plans, and client and staff files. LPA will document Technical Advisory note on LIC9102TV concerning LIC9182 transfer forms that were missing for S1 and S2. No fire arms, weapons, ammunition, or bodies of water are present at the facility. Component III presentation was conducted with licensees and LPA during the visit. No deficiencies were cited at the time of the visit. An exit interview was conducted were this report was reviewed and provided to facility licensee, Aleksandar Boskoski.