Pre-licensing visit·April 24, 2026

Licensing Program Analyst (LPA) Carmen Lopez conducted an announced Pre-Licensing/Component III inspection at the facility. LPA was greeted at the front entrance by applicant Colin Smyth and granted entry after identifying herself and disclosing the purpose of her visit. The facility is undergoing their new licensure and COMP III inspection. An overall inspection of the facility was conducted inside and out. The facility has six (6) resident rooms of which four (4) are non-ambulatory, one (1) is ambulatory, and 1 is non-ambulatory/bedridden. There are two (2) bathrooms for residents to use. The facility has all the required furnishings, linens and personal hygiene items. Bathrooms are equipped with grab bars and non-skid mats. Water temperature measured within the allotted temperatures for bathrooms. A bathroom had a mirror that may be used as a night-light, and an additional light was ordered during the inspection. All outdoor and indoor passageways were free from obstructions. Fire extinguishers were recently purchased (02), and applicant was aware they will need to be affixed with current tags yearly. Smoke and carbon monoxide detectors were present and operational. Each window had a screen which was in good condition. The licensee has no bodies of water on the premises, nor do they store any weapons or ammunition. All toxic substances were stored in the locked garage which is inaccessible to residents. The facility kitchen was stocked with appropriate cooking items; knives were placed in a locked inaccessible cabinet. (Continuation on LIC809-C) (Continuation of LIC809) There were perishable and non-perishable food items stored in the cabinets and refrigerator, but applicant was aware that a seven (7) day non-perishable and two (2) day perishable food supply will need to be present at all times when residents are admitted. Medications will be secured in a locked cabinet which is inaccessible to residents. A first aid kit was present and readily accessible. A first aid manual was purchased during the visit and will be delivered. All items purchased will be delivered between 04/25/26 - 04/26/26. Residents and staff files will be placed in a locked cabinet in an inaccessible area. Facility met all posting requirements. Discussed with the applicant were continuing operation requirements, record keeping, reporting requirements and physical plant compliance. The Pre-Licensing and Component III were completed on today’s date. The facility is ready for licensure pending management approval. An exit interview was conducted with applicant Colin Smyth and a copy of this report along with the licensee Appeal Rights (LIC 9058 01/16) were provided at the conclusion of the visit. The signature on this form confirms receipt of these documents.