Pre-licensing visit·December 4, 2024

On 12/04/2024 at 8:55 AM LPA Marcela Yanez conducted an unannounced Pre-licensing Inspection for a change of ownership. LPA met with Applicant, Daisy Estoesta.The home currently has 4 residents. Which is approved for age 60 and over. Fire Clearance for 6 Non-Ambulatory residents in rooms 2-5 Room 1 is for staff only, no hospice waiver on file, Dementia plan submitted. LPAs toured the facility inside and out. The facility is equipped with 8 smoke and carbon monoxide detectors in working condition. Fire extinguisher observed in the home which was serviced on 04/24/2024. The kitchen, dining and living room were observed in good repair. The home is equipped with a Pull fire alarm system which was serviced on 04/24/2024 Kitchen was equipped but not limited to microwave, working stove and refrigerator temperature measured at 37 degrees F and freezer 0 degrees F. Kitchen water measured with thermometer at 112.1 degrees F. Knives and toxics were locked in cabinet. 2-day perishable and 7-day non-perishable food were observed in the kitchen. A garage was observed during inspection with laundry area and staff refrigerator and area being used as office. Resident bedrooms were observed in good repair, furnished, with clean linens and adequate lighting. 3 Bathrooms were observed clean and equipped with grab bars and non skid mats. The water temperature range for facility bathrooms were measured with thermometer at 108.8 to 110.1 degrees F. Centrally stored medication cabinet with first aid kit that was complete with gauze, tape, tweezers and first aid guide was observed locked. All outdoor and indoor passageways including ramp in backyard were observed clear and free of obstruction. The backyard was inspected, no bodies of water observed. Page 1 of 2 Page 2 of 2 During inspection LPA observed a locked shed that is being used for storage and not a living quarters. Component III orientation was completed with applicant. 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 Applicant, Daisy Estoesta and a copy of the report was provided.