Pre-licensing visit·July 13, 2021

Licensing Program Analyst (LPA) Rachael De Leon conducted an announced pre-licensing visit. LPA met with Zolton Soo, Administrator and explained the purpose of the visit. Applicant took LPA on a virtual plant tour of the inside and outside of the facility and the following is noted: Medications: There is a locked medication cart off of the dining room area. A small locked refrigerator is available for any refrigerated medications in the staff office area. Physical Plant: The facility is 14 bedroom with 13 single bedrooms and 1 shared bedroom, 4 shared resident bathrooms and 1 staff/visitor restroom, kitchen, dining room, living room, and locked laundry room. The facility has delayed egress on all exiting doors and the resident backyard patio has a secured fence with key coded gate for entry/exit. Facility is clean, sanitary and in good repair. Indoor and outdoor passageways, open porches, and other areas of potential hazard are free of obstructions. The facility does not have any pools or bodies of water. The facility does not store any firearms or ammunition. Any dangerous products/tools will be stored in locked cabinets and cupboards. All windows screens are clean and in good repair. Facility temperature is between 68-85 degrees. Facility does have areas with secured hand railings. The facility has smoke and carbon monoxide detectors. Bedrooms: The facility has 14 resident bedrooms and 1 is for double occupancy. Bedroom have beds for each resident with mattress, mattress pads, bed springs and pillows which are clean and in good repair. Mattresses and pillows are flame-retardant. The rooms have dressers and plenty of closet space for residents. The rooms are furnished with chairs and proper lighting /or lamps in each room for residents. Continued 809-C Bathrooms : The facility has 5 bathrooms, 1 for staff/visitors and 4 for residents use, all bathrooms have toilets and sinks. 2 bathrooms have showers. Bathrooms are located near resident rooms. There are night-lights in the hallways outside non-private bathrooms. Supplies: The facility has a sufficient supply of resident personal hygiene supplies, clean linens, towels and wash clothes. The supply of linens is sufficient for changing weekly or more if needed. Food Service: Dining room is near kitchen, Refrigerator and freezer are clean and large enough for the storage of at least two days of perishable food. Freezer is 0 degrees Fahrenheit and refrigerator was at 40 degrees which meets regulation requirements. A seven day supply of non-perishable food is present. There are sufficient amounts of tableware, tables, dishes, and utensils. There are sufficient amounts of equipment for the storage, preparation and service of food. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean. Records: The facility has confidential storage for personnel and resident records, they will be kept on shelves in locked office areas. Administration: The facility has emergency plan and phone numbers posted, Residents rights, Facility visiting policy, Licensing Complaint Poster is posted in a prominent place at the facility. The facility has space for resident council meetings and resident council postings if needed. Activities: the facility has an activity calendar posted. There is an outdoor space with a shaded areas and furnished for outdoor use. There is at least one common room available for residents visitors. There are activity supplies, Art and crafts and games with a variety of reading material available. Miscellaneous: The facility has a current first aid manual with a first aid kit and all required supplies are present. There is working equipment for laundry. There is space for clean linen storage and separate space for soiled linen. The facility has an operating telephone available for residents use. Emergency lighting and supplies to include flashlights with batteries, emergency food supply and water is available for emergency use. Exit interview conducted, copy of report emailed to Applicant.