Pre-licensing visit·April 10, 2025

On April 10, 2025, at 09:00 AM, the Licensing Program Analyst (LPA) Kiran Jain arrived announced at the facility to conduct a Pre-licensing visit to follow up on the deficiencies that were observed on March 06, 2025, during previous Pre-licensing inspection. The LPA met with the Administrator, Ying Wang, and disclosed the purpose of the inspection. There were no residents present at the facility at the time. The facility has an approved fire clearance for (6) non-ambulatory residents. The facility is a single-story building with 6 bedrooms, 4 bathrooms, a living room, kitchen with dining area, a laundry area, and a garage. On March 06, 2024, deficiencies were observed and documented in the Pre-licensing visit report. During today's (04/10/2025) visit, LPA observed beds, mattresses, bedsheets, pillows, chairs, nightstands, and chest of drawers in all residents’ rooms. There were grab bars in shower and toilet, paper towels, soap, and trash cans in all four (4) bathrooms. A sturdier TV stand was observed in the living room. Scissors and tweezers were found in the first aid kit. Cleaner blinds and shades, paint chip offs and scratches were fixed throughout the facility. A patio table, chairs, and umbrella along with a side yard fence door were observed in the backyard. COMP III was reviewed and completed with the Licensee. No issues were noted during the Pre-licensing inspection prior to the licensure. LPA 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. Continued on LIC809-C No deficiencies were cited during today's visit. An exit interview was conducted with the Licensee. A copy of this report was provided to the Licensee, Ying Wang, whose signature on this form confirms receipt of the report.