Pre-licensing visit·June 30, 2025

On 06/30/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived announced to this facility to conduct an annual visit. LPA met with applicant, Golalai Matin and explained the purpose of the visit. The purpose of this visit was to conduct a Pre-Licensing Visit. This facility will hold 6 residents, of which 3 may be non-ambulatory and 1 may be bedridden. This facility also has a dementia plan on file with a hospice waiver for 2 residents. Current census was 0. A brief interview with applicant Matin was conducted. The perspective facility administrator has an active administrator certificate # 7030250740 and expires on 10/06/2025. A tour of the facility was conducted. A tour of the kitchen was conducted. LPA observed a sufficient amount of 2-day perishable and 7 day non-perishable food supply. LPA observed knives and toxins locked and made inaccessible to residents in care. A medication cabinet was identified in the cabinet in the kitchen. A fire extinguisher was also located in the kitchen and was purchased on 04/17/2025 with a receipt attached to it. A tour of the back yard was conducted with no hazards present. Perimeter fence and exit gates were observed to be in good repair. A tour of the living area, dining area, and other areas intended for resident use was conducted. Furniture was observed to be in good repair and meet resident needs. A tour of 2 bathrooms were conducted. Hot water was taken to ensure compliance within regulation. Grab bars were present and in good repair. A tour a 4 resident bedrooms were conducted. Resident furniture was observed to be in good repair and meet residents needs. Rooms #1 and #2 are able to house non-ambulatory residents. Bedroom #1 may be one bedridden resident. Bedroom #3 and #4 may only house ambulatory residents. A tour of the laundry room was conducted. Toxins and other cleaning supplies were identified and made inaccessible to residents in care. A linen closet was identified and presented a sufficient amount of linens to meet the needs of the residents. Emergency lighting was present throughout the home. Carbon monoxide and smoke alarms were observed and tested to ensure it was in proper working condition. Based on the observations made during this visit, this applicant has passed the pre-licensing inspection. Component III was reviewed with this applicant. An exit interview was conducted and a copy of this report was provided to the applicant at the end of this visit.