Pre-licensing visit·March 12, 2025

Licensing Program Analyst (LPA), Tiffany Holmes conducted an announced Pre-licensing inspection. An initial application to operate a Residential Care Facility for the Elderly was received on 10/10/2024. The facility was approved to care for six (6) Elderly Residents; six (6) Non-Ambulatory and six (6) hospice. LPA was greeted and allowed entry into the facility by and met with Arceli Songco, Administrator Structure - The facility is a single story structure with 7 bedrooms and 4 bathrooms, 3 of which will be used for resident and 1 staff. There is an outdoor covered area for resident use. No bodies of water were observed. Bedrooms Residents - Rooms #1, #2, #3, #4, #5 and #6 for Non-Ambulatory one (1) for staff Bedrooms Staff - staff are using Room #7 Bathrooms - All bathrooms have a working toilet, sink, grab bars and tub/showers with non-skid mats. The bathroom next door to the room is used only by staff. 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 105- 109.4 degrees F. Medications- Centrally stored and locked in a cabinet. First-Aid Kit - Stored in a locked cabinet. Resident & Staff Files - Located cabinet. Activities - Adequate supplies to include games and puzzles for resident's use. Fire clearance - Approved on 12/13/24. 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. 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 Arceli Songco, Administrator signature below confirms receipt of these rights.