Pre-licensing visit·May 24, 2022

Licensing Program Analyst (LPA) Michael Bilger conducted an announced pre-licensing visit to this facility on 05/24/2022 at 2:00pm and was met by the Applicant, Jean Alvarez , Brief interview was conducted with the Applicant. It was learned that this facility will be licensed as a Residential Care Facility for the Elderly (RCFE) to serve up to 6 non-ambulatory clients. There were no clients present during today's pre-licensing visit. Tour of the facility was conducted. Dining area, living area, and all other areas intended for resident use were toured and observed to be furnished and maintained in compliance at this time. COVID Precautions in place including signage, PPE storage and 30-day supply. Isolation rooms designated. COVID-19 Mitigation plan is in place. LPA observed no obstruction of emergency exits. Exit signs in place as appropriate. Fire extinguisher in various locations including kitchen, living room, laundry room, and outside area, and are fully charged. Facility map indicating emergency exits posted in appropriate locations. Complaint poster and Ombudsman Poster observed. Kitchen area was toured. Cabinets and drawers were opened and reviewed by this LPA along with the Applicant. Areas for sharp objects and toxins were secured with lock. Medication cabinet, located in the kitchen area, was toured. First aid kit was observed to be present and contained all required components at this time. A tour of the resident bedrooms was conducted. Furnishings and furniture intended for use by the clients were observed to be sufficient and able to meet the needs of the clients at this time. A tour of the resident bathrooms was conducted. {Cont. on 809C} Hot water temperatures were taken and measured between 105-120*F . Linen closet, located in the hallway, was observed to contain a sufficient supply of towels and linens able to meet the needs of the residents at this time. A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time. A generator is in place in case of power outage. This facility has been found to be in compliance at this time. There were no deficiencies observed during today's Pre-licensing visit. Component III completed with applicant during visit. Exit Interview conducted with Jean Alvarez . A copy of this report was left with Jean.