Star Residential

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Arian Golbakhsh conducted a scheduled Pre-Licensing Inspection and Component III Training. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Licensee/Administrator Albert Souza. The facility's planned capacity is for six (6) non-ambulatory residents, one (1) of which may be bedridden. Bedridden resident may reside in bedroom #4 only. As the facility is undergoing a change in ownership, during today's inspection there were four (4) residents in care. Staff present and providing care under the current/soon to be former licensee were all verified to have valid background clearances. LPA, Administrator Souza, and House Manager Emily Purvis toured the interior and exterior of the facility and inspected each room. Facility sketch was consistent with the current layout of the facility. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: common bathroom sink measured at 106.3F and kitchen sink read at 111.9F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked and inaccessible for residents in care. [Continued on LIC 809-C] [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients. Centrally stored medication cabinet was locked, per regulation. No pools or bodies of water exist on the premises. Per Administrator Souza, no firearms or ammunition are kept at the facility. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months, dated for April 2025. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA conducted the Component III Training with Administrator Souza and House Manager Purvis. LPA also answered additional questions regarding regulations and responsibilities and provided resources for Licensing Forms and best practices. No immediate health and/or safety concerns were observed during today's visit. LPA observed residents and did not note any licensing or regulatory concerns. The facility's request for licensure will be forwarded to management and the Centralized Application Bureau (CAB) for final review and approval. An exit interview was conducted with Administrator Souza to whom a copy of this report was provided. Their signature below confirms receipt of this document.the state’s words, verbatim · CDSS document, Dec 1, 2025

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 4 Method: Telephone call with CAB COMP II Participants: Angulo, Patsy; Souza Albert On 11/5/2025, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Nov 5, 2025