Pre-licensing visit·July 10, 2025

Licensing Program Analysts (LPAs), Tiffany Holmes and Ramin Hashemi conducted an announced Pre-licensing inspection. An initial application to operate a Residential Care Facility for the Elderly was received on 05/28/2025. The facility was approved to care for four (4) Elderly Residents. LPAs were greeted and allowed entry into the facility by and met with Applicant, Sally Saif. Structure - The facility is a single story structure with 3 bedrooms and 2 bathrooms. There is an outdoor covered area for resident use. No bodies of water were observed. Bedrooms Residents - Rooms #1, #2, & #3, ambulatory use only. Bedrooms Staff - no staff room. 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- connected. Appliances - Stove burners, oven, microwave, washer, and dryer working. Toxins - Stored in a locked cabinet. Water Temperature - Measured at 108 degrees F. Medications- Centrally stored and locked in a cabinet in the kitchen. First-Aid Kit - Stored in a locked cabinet. Resident & Staff Files - will be kept in locked cabinet. Activities - Adequate supplies to include magazines and puzzles for resident's use. Fire clearance - Approved on 03/20/2025. 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 Applicant, Sally Saif signature below confirms receipt of these rights.