Pre-licensing visit·August 12, 2025

On 08/12/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced prelicensing inspection. LPA met with administrator Villarose Gratuito and new licensee Katie Eiseman and Thomas Eiseman during today's visit. LPA explained the purpose of today's visit. LPA was allowed entry into the facility. This is a single level facility approved all residents to be non-amblatory and 6 hospice residents. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. There are no hospice residents at this time. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the kitchen in a drawer adjacent to the facility stove. Medications are observed to be locked in a closet with the first aid kit near the dining room. First aid kit is observed as complete with required items. Perishable and non-perishable food items are observed as in place. There are additional refrigerator and freezer in the garage area which also carry additional food supplies. LPA observed that there are multiple fire extinguishers in place inspected 08/2024, smoke detector, carbon monoxide detectors are observed in place through out the facility, and central heating/cooling system. The facility has a full fire sprinkler system through out the facility. PPE and additional food supplies are observed as in place. Laundry area is also observed as fully operational. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Last emergency/disaster drill was conducted on 06/24/2025. Water temperature was measured at 115F in the common full bathroom in the main hallway connecting to the resident rooms. Continued on next page... Page 2 LPA observed rooms numerous resident rooms and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Residents on the the left side of the hallway have shared half baths. Resident linen supplies are observed as in place in the laundry room. Cleaning supplies are also observed as locked inaccessible to residents in care beneath the kitchen sink and garage. There is a staff room connected to the living room. Administrator certificate is observed as expiring April 2026. Files are reviewed for 8 out of 10 residents. All are current. Files for 4 staff are reviewed as well and all are current. Component 3 is conducted during today's visit. No citations issued. Report is reviewed with the administrator and licensee a copy is provided on this day. LPA Vado will inform CAB of completion of the prelicensing inspection.