Pre-licensing visit·January 3, 2025

Licensing Program Analyst (LPA), Natasha Persaud conducted an announced second Prelicensing inspection. An initial application to operate a Residential Care Facility for the Elderly was received on 06/05/24. The facility was approved to care for six (6) Elderly Residents; four (4) Non-Ambulatory and two (2) Ambulatory. The purpose of the visit was to inspect items that required completion on the first prelicensing inspection was on 12/20/24. LPA was greeted and allowed entry into the facility by and met with Applicant, Josephine Tayaba . Structure - The facility is a single story structure with 5 bedrooms and 2 bathrooms. No bodies of water were observed. There is also an Additional Dwelling Unit behind the facility with a separate entrance. Bedrooms Residents - Rooms #1 and #5 may be used for Non-Ambulatory; Rooms #2-#4 ambulatory use. Bedrooms Staff - Room #3 is for staff use only. Bathrooms - All bathrooms have a working toilet, sink, grab bars and tub/showers with non-skid mats. Linens & Hygiene Supplies - Adequate supply. Emergency Phone Numbers, Exit Plan and Required Postings - Posted. Smoke Detectors and Carbon Monoxide Detectors- Interconnected and hardwired. Appliances - Stove burners, oven, microwave, washer, and dryer working. Toxins - Stored in a locked cabinet. Water Temperature - Measured at 117 degrees F. Medications- Centrally stored and locked in a cabinet. First-Aid Kit - Stored in a locked cabinet. Resident & Staff Files - Stored in locked cabinet. Activities - Adequate supplies board games, puzzles, and magazine's for resident's use. Fire clearance - Approved on 09/23/24. Component III - Conducted at the Pre-Licensing visit. Information provided about how to operate the facility within substantial compliance. All items reviewed during the visit are in compliance. Prelicensing is complete and this facility has no deficiencies. Facility appears to be ready for licensure pending final review. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Applicant, Josephine Tayaba whose signature below confirms receipt of these rights.