Pre-licensing visit·April 15, 2025

Licensing Program Analyst (LPA) Rankin arrived at the facility announced at 3:03 p.m. to conduct a pre-licensing inspection. LPA met with Administrator Aurea Alejandro. This is a change of ownership application from Pedflor Alejandro, LLC. to Pedflor Alejandro I LLC. The current census is three (3) residents. The fire clearance was granted on 12/18/24; in which two (2) rooms were cleared for non-ambulatory residents and one (1) room for bedridden residents. Component III was reviewed with administrator for Residential Care Facility for the Elderly (RCFE)’s. The LPA toured the physical plant areas inside and outside with the applicant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. BEDROOMS : There are four (4) bedrooms in the facility; the facility has three (3) rooms for resident use, and one (1) staff room. Staff room is kept locked. All resident rooms have doors to the outside. Lighting in the rooms appeared adequate. All rooms were set up with beds, night stands, lamps, chests of drawers, chairs and closet space. BATHROOMS : There is two (2) full bathrooms for resident use. The bathroom in the hallway is designated for staff and resident use, one (1) bathroom is in a private room designated for resident use. The showers are equipped with nonskid surfaces and available nonskid mats. Grab bars were observed in the bathrooms. Continued on LIC 809-C. COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment in the living room area. The facility smoke alarm system was tested and working at time of visit. There is a charged fire extinguisher located in the living room area. Last inspected in August of 2024. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted. All other required postings are also posted in the hall and common areas. KITCHEN: Kitchen knives are stored locked and inaccessible in a drawer on the left side of the kitchen sink. The supply of perishable and nonperishable food is adequate. The supply of dishes is adequate. Appliances in the kitchen are clean and functional. There is an adequate supply of emergency food. MEDICATIONS: Medications are in a locked cabinet in the kitchen. The first aid supplies were complete. FILES: Resident and staff records were reviewed and complete. LAUNDRY: The laundry area is located in the attached garage. Laundry detergent and chemicals are locked and stored inaccessible. EXTERIOR: The exterior passageways were clean and clear of any obstructions. The backyard is set up with a table, which is located under a shaded structure along with chairs for resident use. There are no bodies of water noted on the premises. The back and sides of the house are separated from the front yard by gates. Gates have a self-latching mechanism. There are no other structures on the property. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. If needed, the facility has the capacity to designate a single isolation room if needed. Facility is in compliance with Title 22 Regulations at this time. This report will be sent to the Centralized Application Bureau (CAB). The CAB Analyst will notify the applicant when the license has been approved. The applicant is aware that they are unable to operate under the new license number until they have been notified that the license has been approved by the CAB Analyst. Failure to comply could affect approval of the license. Exit interview conducted and report issued.