Pre-licensing visit·March 17, 2026

At approximately 09:45 AM, Licensing Program Analyst (LPA) Star Stevenson arrived ANNOUNCED to conduct a Pre-licensing Facility Inspection with applicant. Facility has both a Dementia Care and infection control plan on file. Facility has fire clearance for 6 residents with capacity to care for 4 non-ambulatory residents, 2 bedridden residents and has a hospice waiver for 2 residents. Room 1 is cleared for ambulatory residents, rooms 3,4, 5 are cleared for non-ambulatory residents and bedroom #2 is cleared for a bedridden resident. Facility has locking pantry for food and sharps, it was recommended to consider use of electronic door knob to make compliance easy for all staff. In addition, facility has locking draws in the hallway to garage for toxins and other supplies that might pose a risk to residents in care. Grab bars and nonskid mats were present. Licensee was advised that community cloth towels are not permitted in shared bathrooms. Hot water temperature in resident's bathrooms were found to be 141F and licensee was advised that water temperatures for resident use must be maintained between 105-120F and licensee immediately turned their water heater down. Medications will be centrally stored and locked in living room cabinets. Kitchen appliances, utensils, and food preparation areas are in good condition. Seven day supply of non-perishable food was present. Facility has two (2) fire extinguishers that are charged and last inspected 11/2025 and licensee was asked to mount each fire extinguisher in a prominent location for emergences. Continued on LIC809 C Continued from LIC809 Combination smoke and carbon monoxide detectors were tested and found to be centrally wired and operational. Facility has a large gas generator for use in emergencies. Windows, doors, walls, ceilings, screens, paint, and furniture are in good condition. Facility features a very large flat patio and well built patio covering to provide shade and sun for residents in care. Side fence has an operational latch and fences are in good repair. A plastic shed was observed to have hardware and other supplies with a functional combination lock to secure. Bathroom #2 is missing grab bars over the bathtub and along the toilet. Based on the findings during this inspection the following items require completion before licensee: Facility will need to install grab bars at bathtub and along toilet in bathroom number 2. Applicant agrees to complete items by Friday March 20th and will send LPA photo proof of completion. Upon completion of installation, the application will be submitted for final approval of license to the Licensing Program Manager. Applicant was advised of the requirement to notify licensing once they receive their first resident in care and will need to submit evidence of appropriate Liability Insurance once they accept their first resident. Facility does not plan to manage P&I money at this time. Component III orientation was conducted at facility. Applicant conveyed a good knowledge of Title 22 regulations. Report was reviewed with licensee, whose signature denotes approval.