Pre-licensing visit·July 8, 2025

On 07/08/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced prelicensing inspection. LPA met with administrator Maria Roias and explained the purpose of today's visit. There is 3 staff and 4 residents present. One of which is the administrator. LPA was allowed entry into the facility. This is a single level facility that is cleared to be all non-ambulatory residents. There is 1 resident on hospice at this time. The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the medication room adjacent to the kitchen. Medications are observed to be locked in a medication room which appeared organized and well kept. Perishable and non-perishable food items are observed as in place. There is an additional refrigerator and freezer in the garage area which also carry additional food supplies. First aid kit is observed as complete with required items. LPA observed that there are two fire extinguishers in place with an inspection date of 05/07/2025, smoke detector/carbon monoxide detectors are observed in place through out the facility, and central heating/cooling system in place. PPE and additional incontinence supplies are in place in the facility garage. Laundry area is also observed as fully operational located in the garage. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Last emergency/disaster drill was conducted on 03/10/2024. Water temperature was measured at 105F in a common full bathroom adjacent to the living room. Shower floors use non-skid mat when shower is in use. LPA observed rooms at random and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Resident linen supplies are observed as in place in a hallway closet adjacent to the living room. Continued on next page... Page 2 LPA reviewed 4 resident files and also reviewed 3 staff files on this day. Per resident files reviewed they are current. Per staff files reviewed all files were current with training and CPR/First Aid. Client medications are inspected and are current including facility medication administration records. Administrator certificate is observed as current expiring on 01/11/2027. Component III is conducted on this day with Maria. No citations issued on this day. LPA will notify CAB of completion of this prelicensing inspection to recommend its licensure. Report is reviewed with Maria Roias and a copy is provided.