Pre-licensing visit·January 19, 2024

Licensing Program Analysts (LPAs), Martha Arroyo Valeria Conway conducted a pre-licensing visit to this property at 9:00 a.m. on 01/19/2024 and met with Applicant Representative Julie Ann Arcenas as this is a change of ownership application from Bernadette Home Care III #567609985 to Happy Home Villa #565850405. The applicant has obtained fire clearance for a total capacity of six (6) non-ambulatory residents in bedrooms #1 - #4. The facility has a dementia program in place. LPAs inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. At 9:26 a.m., all hard-wired smoke alarms and carbon monoxide detectors were tested and function properly. LPAs observed two (2) fire extinguisher to be new and fully charged on 06/15/2023. There are two (2) single occupancy bedrooms and two (2) double occupancy bedrooms for resident use and one (1) staff room. Each bedroom is equipped with clean mattresses, pillows, and bedding. There is a closet in the hallway with a sufficient supply of linens, including blankets, bath towels and wash cloths. Bedrooms have sufficient lighting. The facility has two (2) bathrooms for resident use. Resident bathrooms contained appropriate non-skid mats and grab bars. Bathrooms have sufficient paper products. Hot water temperature was measured in both bathrooms, and they measured between 105- and 120-degrees Fahrenheit. LPAs observed trash cans with tight fitting lids at the time of the visit. LPAs toured the kitchen area at 9:20 a.m. The facility has at least seven (7) day supply of non-perishable food and two (2) days perishable food. Appliances and all equipment appear to be clean and in good repair. Kitchen knives and sharps were observed in a drawer next to the kitchen sink locked and inaccessible. The kitchen has a sufficient supply of plates, cups, cookware and utensils. (Report Continued on LIC 809C...) (Report Continued from LIC 809..) The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. Enough seating for six (6) residents at the same time in the dining room table. A working telephone is present. There are activity supplies in the living room. Night-lights were present in the main hallway and common areas. All doors have functioning auditory alarms when opened. Facility will have one central entry point designated for universal screening. Alcohol-based hand sanitizer and masks available upon entry. Facility has an adequate 30-day supply of Personal Protection Equipment (PPE). Medications are stored and locked in the hallway closet. Facility records are stored in a file cabinet adjacent to the kitchen. First aid kit was observed to have bandages, thermometer, scissors, tweezers and a current first aid manual. The garage is attached to the house and is locked at all times. The laundry room is kept locked and inaccessible at all times. Detergents, disinfectants, and cleaning supplies are stored and inaccessible. There will be no firearms/ammunition stored on the property. There is a sufficient supply of emergency food and water. The facility has required postings, including emergency exit plan, Licensing Complaint Poster, Resident Personal Rights, Theft and Loss Policy, and Resident Council Rights. The exterior passageways were clean and clear of any obstructions. There is one (1) self-latching gate for emergency use. There are no bodies of water on the premises at the time of the visit . LPAs observed the backyard, which has a covered outdoor area with a table and chairs for resident use. Physical plant is consistent with the submitted facility sketch / floor plan. Comp III conducted with Applicant Representative. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. The report was reviewed, and a copy was provided.