Pre-licensing visit·February 27, 2026

Licensing Program Analyst (LPA) Zabel chochian conducted a Pre-licensing visit and met with the Applicant Rowena Marantal Carrillo. This is a new facility with a Hospice Waiver approved for six (6) residents. The facility is single story house located in a residential neighborhood with an attached garage. At 9:45 a.m. a physical plant tour was conducted inside and out. An approved fire clearance was received, approved for six (6) non-ambulatory residents in bedrooms 1-6. The facility's bedridden capacity is approved for one (1) resident. The facility has six (6) private resident bedrooms. Bedrooms 2,3,4,5 and 6 have direct exits to the facility. All resident bedrooms 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, a mattress, 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 a wheelchair or walker. All window screens were clean and maintained in good repair. There are three (3) total bathrooms of which two (2) are private resident bathrooms, and one (1) shared /common resident bathroom. The resident bathroom(s) have a shower with shower mats. The toilets and showers have grab bars. Bedrooms 1 and 6 have a private bathroom. The hot water temperature was tested in all bathrooms and the kitchen and was found to be within the range of 105*F and 120*F degrees Fahrenheit. The supply of extra bed and bath linens is adequate. Resident and staff records are stored/secured in the kitchen cabinet. Medications will also be centrally stored/secured in the kitchen cabinet. Medications requiring refrigeration will be kept in a locked box inside the refrigerator. The first aid supplies observed complete, including a thermometer and a current version of the first aid manual. These supplies are also stored/secured in the kitchen cabinet. Kitchen knives are stored in a locked cabinet in the kitchen. Stove burners maybe made inaccessible to the residents by removing them when not in use. (Continue to LIC809c) The supply of dishes, utensils, pots, pans and drink ware is adequate. The supply of nonperishable food is adequate. Appliances in the kitchen were clean and all appeared functional. 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 and dining area. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were installed in hallways resident rooms and passageways to non-private bathrooms during today's visit. 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 the living room. It is screened and there are no tools. Alarms were installed during the visit on all exterior doors. Alarms were engaged and functional. The physical plant is consistent with the submitted facility sketch/floor plan. The facility has flashlights for emergency use. 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. The smoke detectors, fire door and carbon monoxide detectors were tested at 10:30 a.m. and functioned properly during the time of visit. There is one (1) fire extinguisher located in the kitchen that was fully charged and purchased on 02/27/2026 receipt observed during visit. The garage is accessible from the house. There is also a separate laundry room includes cleaning supplies, detergents, washer and dryer. Personal hygiene items (shampoos, soaps) were adequate and are stored in the locked cabinet in the hallway. Extra incontinence supplies, and personal protection equipment (PPE) are stored in the hallway cabinet as well. There is a functioning telephone on the premises. The emergency exiting plans/sketch and emergency telephone numbers are posted in the kitchen/dining area. Other required postings are posted throughout the facility including hallways and kitchen/dining room. The exterior passageways were clean and clear of any obstructions. Patio tables and chairs observed in the backyard where residents can sit. The entire property is fenced. The back and sides of the house are separated from the front yard by gates. Component III orientation was completed with applicant during visit. Prelicensing site visit requirements met. 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. Copy of the report was reviewed and provided.