Pre-licensing visit·October 9, 2025

Licensing Program Analyst (LPA), Martha Arroyo conducted a pre- licensing visit to the facility noted above at 10:00 a.m. Upon arrival, LPA met with Applicant Representative, Jennifer Pantig as this is a change of ownership application from Love Circle Home Care LLC #565802407 to Love Circle Home Care #565850456. The applicant has obtained fire clearance for a total capacity of six (6) residents, of which one (1) may be bedridden in bedroom #4. The facility has a dementia program in place. Hospice waiver approved for three (3) residents. LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The smoke alarms and carbon monoxide detectors were tested and function properly. LPA observed two (2) new fire extinguishers with a purchase date of 08/07/2025. There is one (1) double occupancy bedroom and four (4) single occupancy bedrooms for resident use. There is no staff room on premises. Facility has 24-hour wake staff. Each bedroom is equipped with clean mattresses, pillows, and bedding. Bedrooms have sufficient lighting. There is a closet in the hallway with a sufficient supply of linens, including blankets, bath towels and wash cloths. There is a locked closet with the residents personal hygiene items. 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. LPA observed trash cans with tight fitting lids at the time of the visit. Report Continued on LIC 809C... Report Continued from LIC 809... LPA toured the kitchen area at 10:20 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 locked and inaccessible under the kitchen sink. The kitchen has a sufficient supply of plates, cups, cookware, and utensils. 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 and family room. LPA observed a fireplace adequately covered. Night-lights were present in the common areas. Medications are stored and locked in the hallway closet. First aid kit was observed to be complete next to the medications. The garage is attached to the house and inaccessible to residents in care. There is one (1) additional refrigerator in the garage with extra food for residents. The washer and dryer was observed inside the garage. Detergents, disinfectants, and cleaning supplies are stored locked 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) gate with latching mechanisms for emergency use. There are no bodies of water noted on the premises at the time of the visit . LPA observed the backyard, which has a covered outdoor area with a table and chairs for resident use. Report Continued on LIC 809C... Report Continued from LIC 809C... Physical plant is accurate 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.