Pre-licensing visit·June 10, 2025

Licensing Program Analyst (LPA) Angela Barutyan conducted a pre-licensing visit to the facility noted above at 10:32AM. LPA met with Applicant Mary Ann Howe. The applicant has obtained fire clearance for a total capacity of six (6) residents. LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The facility is a single-story home. The facility has three (3) resident bedrooms for shared-use. All resident bedrooms are cleared for non-ambulatory. The hard-wired smoke alarms and carbon monoxide detectors were tested and function properly. LPA observed fire extinguisher to be fully charged and last serviced 07/17/2024. LPA toured the kitchen area at approximately 10:35AM. At 10:37AM, hot water temperature was measured in the kitchen sink and was 121.2 degrees F. Water heater was lowered during the visit. LPA remeasured hot water at 10:48AM and measured at 110.1 degrees F. Appliances and all equipment appeared to be clean and in good repair. The kitchen has a sufficient supply of plates, cups, cookware, and utensils. Knives, sharps, and cleaning solutions were locked in a cabinet under the sink. LPA observed emergency food and water supply in the kitchen. Resident bedrooms are equipped with clean mattresses, pillows, and bedding. Bedrooms have sufficient lighting. There is a sufficient supply of linens, including blankets, bath towels and wash cloths. LPA observed Bedroom #3 with direct exit to the exterior and an adequately screened fireplace. The facility has two (2) bathrooms located in the hallway. One (1) is for resident and visitor use and one (1) is for staff use. Bathrooms contained appropriate slip-resistant surfaces and grab bars. Hot water temperature was measured in bathrooms and were between 107.5-108.1 degrees F, which is within the required range. Report Continued on LIC 809C... Report Continued from LIC 809C... The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. LPA observed enough seating for six (6) residents at the same time. A working telephone is present. There are activity supplies. There is one (1) fireplace in the living room and was observed adequately screened. Night-lights were present in the hallways. Medications will be stored and locked in a closet by the living room. LPA observed a complete first aid kit in the medication closet. Facility records will be kept in a cabinet in the living room. Additional cleaning supplies, toxins, a washer and dryer, detergents, and disinfectants were observed in the detached garage which is kept locked. There will be no firearms/ammunition stored on the property. The facility has required postings, including Emergency Exit Plan, Resident Personal Rights, and Theft and Loss Policy. Outdoor passageways were free of obstructions. There are no bodies of water on the premises at the time of the visit. LPA observed an outdoor area with a table and chairs for client use. All exits had functioning auditory exit alarms. Physical plant is consistent with the submitted facility sketch/floor plan. Comp III conducted with Applicant. Pre-Licensing is complete and this facility has no deficiencies. 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.