Pre-licensing visit·November 22, 2021

Licensing Program Analysts (LPAs) Christine Dolores and Marybeth Donovan arrived unannounced to conduct a pre-licensing visit. LPAs met with Sunil Verma Administrator and Neeru Verma Designee Administrator. There is currently residents living at the facility. The facility has two floors and has an approved fire clearance for 15 non-ambulatory, 15 bedridden, and hospice waiver for 10 hospice residents. LPAs toured the facility inside and outside to include hallways, resident rooms, bathrooms, shower rooms, salon, activity room, living area, kitchen, dining room, patio, and laundry rooms. Elevator is in working condition. Resident apartments were equipped with proper furniture and lighting. Bedding and linens are available to the residents and observed clean. Bathrooms are equipped with grab bars, hygiene supplies, and toiletry. First floor hot water temperature was maintained at 107.3 degrees Fahrenheit. Second floor hot water temperature was maintained at 112.0 degrees Fahrenheit. Facility is equipped with smoke detectors, carbon monoxide detectors, an d fire extinguishers. Hallway and exit routes were observed free of obstruction. LPAs observed the following posters: Personal Rights, If You See Something Say Something, Family Councils, and Resident Right to Counsel posted. Resident Admission Agreement and Theft and Loss policy is available for the public to review upon request. LPAs reviewed 4 resident files and 4 staff files. Facility staff are fingerprint cleared. Resident files all contain the current documents. Continue on LIC809-C. LPAs observed a Thanksgiving feast to include a fruits, yams, dessert, turkey, salad, and cheese tray. Refrigerator temperature was maintained at 35 degrees Fahrenheit. Freezer temperature was maintained at 0 degrees Fahrenheit. LPAs conducted Component III with Sunil Verma Administrator and Neeru Verma Designee Administrator. No issues noted during this pre-licensing inspection. LPAs observed the facility is ready to be licensed. However, this report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. This report was reviewed with Sunil Verma Administrator and Neeru Verma Designee Administrator and a copy of this report provided.