Pre-licensing visit·July 13, 2023

Licensing Program Analyst Ryker Heberle (LPA) conducted an announced pre-licensing inspection on 07/13/2023. LPA met with facility Administrator Rosana Mendoza (Admin). During visit, LPA toured the facility, including living room, 5 resident bedrooms, laundry room/garage, kitchen/dining room, 2 bathrooms, and backyard. The facility is not currently operating and is awaiting the transfer of residents from currently licensed facility. Facility was observed to be clean and in good repair. Carbon monoxide detectors were tested and observed to be functioning properly. Fire extinguisher was inspected in June of 2023. Bathroom hot water temperature was measured at 118.6*F. Facility temperature observed to be 73*F with operational AC. Bathrooms were observed to be stocked with soap and paper towels. First Aid Kit observed to be complete. No open bodies of water noted at facility. Medication cabinet observed to be locked. Facility kitchen equipment is functioning properly, LPA observed locked drawer for sharps. LPA reviewed emergency disaster plan and confirmed its completeness. LPA observed proper storage of cleaning chemicals. Facility bulletin board contained all the necessary documents. Grab bar was not yet installed in shower of one bathroom. Facility emergency evacuation plan observed to not contain details regarding how the facility will evacuate bedridden residents. Facility has not yet created emergency master key set for evacuation purposes. Component III orientation was waived for this facility due to Administrator's prior experience. The physical plant is approved pending the installation of shower grab bar, updating of emergency evacuation plan, creation of emergency master key set, and completion of Centralized Application Bureau (CAB) review of the facility application. Exit interview was conducted and a copy of this report was provided to Administrator Rosana Mendoza electronically due to printer error.