Pre-licensing visit·April 23, 2026

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 10/24/2025. The facility was approved to care for twelve (12) Elderly Residents; and twelve (12) Non-Ambulatory. LPA was greeted and allowed entry into the facility by and met with Applicant, Seiko Iso. Structure - The facility is a single story structure with buildings 6 bedrooms and 4 bathrooms. There is an outdoor covered area for resident use. No bodies of water were observed. Bedrooms Residents - All rooms for Non-Ambulatory use. Bedrooms Staff - none. Bathrooms - All bathrooms have a working toilet, sink, grab bars and tub/showers with non-skid mats. Linens & Hygiene Supplies - 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 107.4 degrees F. Medications- Centrally stored and locked in a medicine cabinet. First-Aid Kit - Stored in a locked cabinet. Resident & Staff Files - will be in locked cabinet. Activities - Adequate supplies to include exercising, games and puzzles for resident's use. Fire clearance - Approved on 04/13/2026. 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, Seiko Iso signature below confirms receipt of these rights. ** Report was amended to correct census from 7 to 0. There were no residents in care at the time of pre licensing visit on 04/23/2026.**