Pre-licensing visit·March 3, 2026

Licensing Program Analyst (LPA) Simi Rai arrived announced to conduct the facility's pre-licensing visit. LPA met with Applicant Nazila Fereydoon . There are 2 residents present on site. This facility address is currently licensed and there will be a change of ownership at this location. During visit, LPA toured the inside and outside of the facility to include the kitchen, dining, living room, garage, laundry room, 4 resident rooms, 1 staff room and 2 bathrooms. There is a locked shed in the backyard which is used for storage space and not a habitual space. All fire exit routes were free and clear of obstruction. Medication, chemicals, sharps and files have designated locked cabinets. Facility has an approved fire clearance for 5 non-ambulatory residents and 1 bedridden resident and approved waiver for 3 hospice residents. Bathrooms supplied with hygiene products and paper supplies. LPA observed the smoke and carbon monoxide detectors to be in working condition. Hot water temperature maintained between 111.9 degrees Fahrenheit - 114.8 degrees Fahrenheit. The following posters observed to include the emergency telephone numbers, personal rights, and facility sketch. Fire extinguisher was purchased on 9/18/2025. No issues noted during this pre-licensing inspection. COMP III was reviewed during visit. 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. This report was reviewed with Applicant Nazila Fereydoon . A copy of the report was provided.