Pre-licensing visit·June 24, 2022

Licensing Program Analyst (LPA) Sabel Martinez, conducted a scheduled Pre-licensing inspection to observe the physical plant for compliance and conduct a Component III. The facility is undergoing a change of ownership, and is approved for six (6) non-ambulatory residents. The LPA was greeted by Administrator, Alicia Olizon, and was granted entry after identifying himself and disclosing the purpose of the visit. An overall tour of the facility was conducted inside and out. The inspection included, but was not limited to, verifying compliance with statutes, regulations and other written requirements that are most relevant to protecting the health of residents in care and staff, including in the area of infection control practices. LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff, residents and visitors; a sign-in policy enacted for all visitors; signs throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area; emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of PPE. Additionally, the LPA observed exterior and interior passageways were free from obstructions. All of the residents’ rooms were equipped with the required furnishings. Residents’ bathrooms were observed to be sanitary and operational. The facility was stocked with a 2 day supply of perishable and a 7 day supply of nonperishable food items. Cleaning supplies and medications were observed to be locked in different locations and inaccessible to residents in care. Per the administrator, there are no firearms at the facility. The LPA discussed continuing operation requirements, record keeping, reporting requirement and physical plant compliance. The Pre-licensing and Component III were completed on today's date. Facility is ready for Licensure pending management approval. This is a change of ownership application and there are six (6) residents currently in care. An exit interview was conducted with Administrator, Alicia Olizon, to whom a copy of this report along with Applicant/Appeal Rights (LIC9058 01/16) were provided to.