Pre-licensing visit·November 15, 2021

Licensing Program Analyst (LPA) Victoria Willis arrived announced to conduct a Pre-Licensing Inspection and met with Applicants, Maricel Aquino and Paulino Buna. Upon arrival, LPA observed a Covid-19 poster on the front door. Once inside, LPA observed multiple Covid-19 posters and a screening station for Covid-19 symptoms that included sign in binders for staff and visitors and a thermometer. Facility is a one story residence with four single bedrooms, one shared bedroom, three bathrooms and common areas. All resident bedrooms are furnished per regulation with a bed, lamp, dresser/closet, chair and bedside table. Bathroom showers have a non-skid shower floor with a bath mat and bathrooms have grab bars to ensure resident safety. Water temperature in bathrooms read at 110, 108 and 105 degrees F which are within regulation of 105 & 120 degrees F. Facility has sufficient items used for meals. Facility has a designated locked drawer for knives or other sharp objects. Perishable and non-perishable foods observed per regulation. Freezer and refrigerator temperatures read within regulation. Facility has a locked desk in the kitchen used for centrally stored medications and files. There is an additional hallway closet that will also be used for files. Cleaning supplies and toxins will be locked in a cabinet in the laundry closet. Other items that may pose a risk to residents in care are locked in an outside shed. Facility backyard has multiple areas for visiting and activities. Facility has a side area that has some uneven ground. Facility is actively working on the area and will be making a pathway. LPA suggested making the area off limits to potential residents until the area is finished. Facility received an approved fire clearance dated September 24, 2021 that allows for up to six non-ambulatory residents and one bedridden resident. Smoke and Carbon Monoxide detectors were tested and operational. Fire extinguishers have been serviced in the last year. Facility has emergency lighting in hallways. LPA confirmed that contents of the facility first aid kit were sufficient and that facility has emergency lighting in case of a power outage. LPA discussed the facility Emergency Disaster Plan with applicant. Facility has submitted their Covid-19 Mitigation Plan. LPA confirmed that Applicant is familiar with Guardian and has read the most recent Provider Information Notices (PINs) that the department sent out regarding Covid-19 vaccinations and visitation. Component III is waived due to Applicant being a current Licensee. LPA will notify Application Unit so application process may proceed.