Pre-licensing visit·December 21, 2022

Licensing Program Analyst (LPA) Steve Chang conducted a pre licensing inspection visit, and met with administrator (ADM) Marie Pendar. LPA did not see the address number plate for the house, ADM stated ADM will pui it on within 7 days. COVID posters and screening station were not observed in the facility, ADM stated ADM will put it on at facility within 7 days. PPE supplies were observed not sufficient for 30 days, ADM stated ADM will put sufficient PPE supplies in facility within 7 days. LPA toured the facility inside out with ADM. LPA inspected living room, kitchen, dinning area, garage and laundry room. Medication closet, knives closet were observed locked. Cleaning product closet in kitchen was observed not locked, ADM stated ADM will fix it within 7 days. There are 6 single rooms for residents, one office, and one staff live-in room in facility. 2 bathrooms were inspected. Non-skid mats and grab bars were observed in bathrooms. There were no posters of washing hands for 20 seconds by the sinks in kitchen and restrooms, ADM stated ADM will put the posters and paper towels with holders in the kitchen and restrooms within 7 days. Room temperature was observed at 72 degree F, and hot water temperature was observed at 116 degree F. The facility is equipped with smoke and carbon monoxide detectors. The facility equipped with fire alarm. ADM tested the smoke and carbon monoxide detectors, and they were working fine. ADM stated the fire extinguishers were bought a month ago, ADM stated ADM will put the receipt on within 7 days. LPA inspected the backyard, there was no obstruction to block the walkway. ADM stated all staff are fully vaccinated and done with booster shots. ADM stated ADM already submitted the Infection Control Plan. Component III orientation was conducted with ADM. No citation noted during inspection. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADM.