Pre-licensing visit·April 4, 2023

Licensing Program Analyst (LPA) Alviso, conducted a pre-licensing inspection, on 4/4//23 at approximately 9:15AM, and met with applicant Bana Solomon, who will be the facility's Administrator once licensed. RCFE Administrator Certificate #6063962740 -expires 8/12/2024. Facility is fire cleared for six(6) non-ambulatory, which includes one(1) bedridden, effective 1/30/23. Applicant has an approved hospice waiver for six(6) residents. Applicant has an approved dementia plan of operation. Applicant has submitted an infection control plan for the home as required. The last inspection was on 3/21/23 and there were a few items that needed to be completed; The LPA has observed that the following items are complete. The iron rails on the ramp leading to the front door have been installed, and the gate on the side ramp has been installed as needed. The kitchen has the stove/range knobs covered so they are inaccessible to future residents in care. The kitchen has a cabinet that can be locked for toxins/cleaners to ensure they are inaccessible to future residents in care. There was a cabinet that is locked and stores the knives. There is a key code lock and key access to a small storage closet in the hallway that will be used to secure medications, and keep them locked and inaccessible to future residents. The two bathrooms have mirrors up, and paper towel holders. The rooms have furnishings for resident use. All postings were up and visible to all as you enter the home, on the wall to the right. Continued on LIC809C... The LPA observed the hallway fire door working properly during the inspection. There were small lamps on the night stands in resident rooms, and the applicant will monitor these ensuring the lamps are bright enough for the future residents in care; The resident rooms do also have ceiling lights. The applicant had the garage cleared and arranged as needed; The garage stores cleaners, toxins, water, overflow food supplies, and the 72 hour shelter in place food supply. Bana Solomon completed component III orientation on 3/21/23. The LPA didn't observe any health and safety hazards during today's inspection, 4/4/23. The LPA will forward a copy of the pre-licensing inspection to the Application Unit Analyst; The Application Unit Analyst will contact the applicant with the status of the application.