Pre-licensing visit·July 14, 2025

Licensing Program Analysts (LPA) Marcela Yanez conducted a unannounced pre-licensing inspection for a change of ownership. The LPA met with Applicant, Lilly LI. The home currently has 6 residents. The facility fire clearance is approved for six (6) non ambulatory and hospice waiver for two (2). On 06/19/25 LPA visited facility to do a Pre-licensing inspection and Pre-Licensing was not completed. On 07/14/25 LPA toured the facility inside and out. The facility is equipped with smoke and carbon monoxide detectors in working condition. Fire extinguisher observed in the home which were all serviced on 10/10/24. The kitchen, dining and living room were observed in good repair. Resident bedrooms were observed in good repair, furnished, with clean linens and adequate lighting. Bathrooms were observed clean and equipped with grab bars. The water temperature range for facility bathrooms were 110.3 to 110.8 degrees F. The water temperature in the kitchen was measured at 108.5 degrees F. Centrally stored medication cabinet with first aid kit was observed locked. 2-day perishable and 7-day non-perishable food were observed in the kitchen. All outdoor and indoor passageways were observed clear and free of obstruction. The backyard was inspected, no bodies of water observed. LPAs observed garage and designated laundry area. LPA observed a locked shed used as storage and not living quarters. Page 1 of 2 Page 2 of 2 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, Lilly Li and a copy of the report was provided.