Pre-licensing visit·May 1, 2025

Licensing Program Analyst (LPA) Esther Cortez conducted a pre-licensing visit to the above noted facility. The LPA met with applicants, Johnna Macanin and Helen Rose T. Busch. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver for six (6) has been requested. Component III was completed during the inspection with the applicants. The facility is a single story home. At 11:50 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing the home for five (5) non-ambulatory residents in rooms #1,#2 and #4, and one (1) bed-ridden resident in room #3. The home has a sprinkler system. The facility has two (2) private bedrooms and two (2) shared bedrooms. Bedroom #2 and #3 has direct access outside. All resident rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. The beds are furnished with comfortable mattress and clean linen; which includes, top and bottom linens, pillowcases, blanket and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. The facility does not have a staff room, therefore will have 24 hour awake staff. All rooms were free of odors. All window screens were clean and maintained in good repair. There is two common restrooms in the hallway and one private restroom in bedroom #2 . The resident bathrooms have showers with non-skid materials. The private restroom has a shower and a bathtub with grab bars and non-skid materials .The hot water temperature was measured in the common bathrooms and ranged between 111.0 F and 113.4 F, within the allowable range of 105*F to 120*F. Report continued on LIC 809-C. Resident and staff records will be stored in a locked filing cabinet in the locked garage. Medications will be centrally stored in a locked filing cabinet in the dining room. Knives and cleaning supplies will be stored in locked boxes inside drawers and cabinets in the Kitchen. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. The supply of perishable and nonperishable food is adequate. There was a three day supply of emergency water . 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. Kitchen, laundry and house cleaning supplies are stored in a locked closet located in the garage. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. The facility has televisions, puzzles, coloring books, books and games for activities. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to non-private bathrooms. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely . There is a fireplace in both living rooms which were screened with no tools. The facility has emergency lighting, which included flashlights, or other battery powered lighting, 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 portable 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. There is a pull station in the hallway outside of room #1 and one of the common bathrooms. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. There are two fire extinguishers throughout the house. They are fully charged and do not exceed the purchase date 11/07/2024. 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, emergency telephone numbers and other required postings are posted at in the entry way of the dining room. Report continued on LIC 809-C, third page. The exterior passageways were clean and clear of any obstructions. There is a covered patio area with outdoor seating. The back and sides of the house are separated from the front yard by a self-latching gate on one side and brick wall on the other. The garage is accessible from the house; the doors were locked from the inside of the house. Toxic or danger items or tools in the garage, were locked in a cabinet during the visit. Infection control practices were discussed with the applicant.. Facility has a 30 day supply of Personal Protective Equipment (PPE) on site. 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 and report issued.