Pre-licensing visit·March 14, 2025

Licensing Program Analyst (LPA), Amy Rodgers conducted an announced Pre-licensing inspection. An initial application to operate a Residential Care Facility for the Elderly was received on 1/24/2025. The facility was approved to care for six (6) Elderly Residents; of which six (6) are Non-Ambulatory.LPA was greeted by, identified herself to, and explained the purpose of the visit to the applicant’s representative, Justin Mendoza. Structure - The facility is a single story structure with 6 bedrooms and 5 bathrooms. There is an outdoor covered area for resident use. No bodies of water were observed. Bedrooms Residents - Rooms #1, #2, #3, #4, #5 & #6 for Non-Ambulatory use. Bathrooms - All bathrooms have a working toilet, sink, grab bars and tub/showers with non-skid mats. Linens & Hygiene Supplies - Adequate supply in the hall storage closet.. 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 and locked under the sink in cabinet. Water Temperature - Measured compliant in the all facets accessible to clients: bathrooms and kitchen. Medications - Centrally stored and locked in a cabinet in the kitchen.. First-Aid Kit - Stored in a locked cabinet in the kitchen Resident & Staff Files - Stored in a locked cabinet in the kitchen. Activities - Adequate supplies to include exercising, and games for resident's use are stored on campus. Fire clearance - Approved on 1/24/25. 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. Pre-licensing 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 Justin Mendoza Administrator signature below confirms receipt of these rights.