Pre-licensing visit·July 16, 2025

Licensing Program Analyst (LPA) Evelin Rios conducted an announced Pre-Licensing Inspection with the applicant representative, Shanna Rucker and the administrator Mohummed Abdullah. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 01/17/2025. A fire clearance was approved on 04/18/2025 for five (05) non-ambulatory residents and one (01) bedridden resident for a total capacity of six (06). At entry LPA observed appropriate postings and a sign in area for visitors. A tour of the physical plant was initiated at approximately 9:30 a.m., and the following was observed: KITCHEN: The kitchen is equipped with a refrigerator, microwave, stove, two ovens and dishwasher. There is a sufficient supply of seven day non-perishable food items, properly stored. Applicant has a sufficient amount of tableware, dishes and utensils to accommodate the capacity of the facility. Knives and sharps were observed locked in a closet by the kitchen. Centrally stored medication, medication records and first aid kit will be locked in a closet by the kitchen. The fire extinguisher is located by the kitchen and was observed fully charged with purchase date 03/15/2025. Facility is equipped with a functional land line and portable telephone. COMMON AREAS: The common areas include the two living rooms and dining area. The common areas are furnished with couches, recliners and televisions. There is a fireplace that is properly screened. The dining room table is large enough to sit the capacity of the facility. Floors and furniture were observed to be in good repair. LAUNDRY: The washer and dryer are located in a locked laundry room. Detergents will be stored in the laundry room. GARAGE: The garage accessible and attached to the house. Cleaning supplies, chemicals and detergents are locked in a cabinet in the garage. LPA observed a staff workstation and resident and staff records will be kept in a locked filling cabinet. BATHROOMS: The facility has three (3) bathrooms. Resident bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water temperature was measured in two (02) bathrooms and was within regulation. BEDROOMS: There are four (4) bedrooms. Per STD 850, Bedroom #3 has bedridden fire clearance. Bedrooms #3 and #4 are shared. The applicant furnished the resident bedrooms with beds, night stand, chairs, chest of drawers, and bedding. The bedrooms have sufficient lighting and closet space. Facility windows and screens were observed in good repair. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alarms when the doors open. The backyard is fenced in and has a patio and appropriate backyard furniture to accommodate six (6) residents. The facility's backyard has sufficient space for outdoor activities. There are no bodies of water. The smoke detectors are hard wired and inter-connected. LPA observed the licensee test one smoke detector and it set off all smoke detectors through out the facility. The facility is equipped with one (01) carbon monoxide detector that was tested and observed to be functioning properly. The applicant representative and administrator completed component III. Pre-Licensing is complete and this facility has no deficiencies. This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. Exit interview was conducted. A copy of this report was signed and provided.