Pre-licensing visit·July 31, 2025

Licensing Program Analyst (LPA) Emily Peraldi conducted a pre-licensing visit to the above noted facility. At 10:00 a.m., the LPA met with Applicant, Arlene Martinez. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver has been granted for six (6) residents. At 10:08 a.m., a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for five (5) non-ambulatory residents and one (1) bedridden resident. The facility is one story residential home. The facility has four (4) resident bedrooms. Bedroom #4 is designated for bedridden and has a direct exit to the outside. All residents’ rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes pillowcases and blanket (if needed). Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are no staff rooms – ‘awake night staff only’ - is required. All rooms were free of odors. All window screens were clean and maintained in good repair. There are two (2) bathrooms in the facility. Resident bedroom #2 has a bathroom inside. The residents’ bathrooms have a shower with non-skid materials. Each shower has grab bars. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. At 10:10 a.m., the kitchen hot water temperature measured at 108.5*F. At 10:23 a.m., the bathroom hot water temperature measured at 105.1*F. Continued on LIC 809-C. Resident and staff records will be stored in a locked hallway closet. Medications will be centrally stored in a locked hallway closet. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. Kitchen knives are stored in a locked cabinet underneath the kitchen sink. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. The common areas were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment, games and/or activity supplies in the living room. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility smoke alarm system is hard wired. At 10:27 a.m., the smoke detector and carbon monoxide detectors were tested and functioned properly. The facility has a central entry point for symptom screening and temperature checks for staff and visitors. There is hand sanitizer available at the entrance of the facility. There is a fire extinguisher near the kitchen. It was fully charged and purchased on 04/24/2025. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted at the entrance of the facility. The emergency telephone numbers are posted near the entrance of the facility. Other required postings are also posted near the entrance of the facility. Continued on LIC 809-C. The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the back of the house. There is one (1) gate with a self-latching mechanism at the side of the house designated for emergency exits. There are no bodies of water on the premises at the present time. The garage is attached to the house and will be inaccessible to residents. Laundry units are located inside the garage. Additional cleaning supplies and household supplies are located inside the garage. Component III was conducted in conjunction with this pre-licensing visit. Pre-Licensing is complete, and no corrections are needed. 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 the approval of your license. Exit interview conducted. A copy of the report was provided.