Pre-licensing visit·May 6, 2025

Licensing Program Analyst (LPA) Rankin arrived at the facility announced at 7:59 a.m. to conduct a pre-licensing inspection. LPA met with Administrator Patricia Hernandez. This is a change of ownership application from Jireh Senior Home to Jireh Senior Home Corporation. The current census is three (3) residents. The fire clearance was granted on 03/17/25; in which four (4) rooms were cleared for non-ambulatory residents and the master bedroom allows for two (2) bedridden residents. Component III was reviewed for with applicant for reminders and updates as the applicant currently operates a Residential Care Facilities for the Elderly (RCFE)’s in good standing. The LPA toured the physical plant areas, inside and outside, with the applicant to ensure there are no health and safety hazards and to ensure the facility is in compliance with Title 22 Regulations. BEDROOMS : There are four (4) bedrooms in the facility for resident use. Master bedroom has door to the outside, this is the only room approved for bedridden residents. 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 showers are equipped with nonskid surfaces and available nonskid mats. Grab bars were observed in the bathrooms. All items that could pose a danger were in locked cabinet under sink. 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 back 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 July 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 cabinet. 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 and water. MEDICATIONS: Medications are in a locked cabinet in the main Livingroom. The first aid supplies were complete. FILES: A sampling of resident and staff records were reviewed and complete. LAUNDRY: The laundry area is located in the attached garage. EXTERIOR: The exterior passageways were clean and clear of any obstructions. The backyard has furniture for resident and visitor 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. There is a locked shed in the back yard. 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.