Pre-licensing visit·February 2, 2022

On 2/2/2022 at 10:30am, Licensing Program Analyst LPA/ Susan Campos conducted an announced visit to Southwoods Living, Inc. facility for purpose of a post-licensing evaluation. An application was submitted to CCLD on 9/27/21, for an initial license application for a Residential Care Facility for the Elderly, ages 59 years and above. The applicant requested for a capacity of six (6) residents, that includes (5) non-ambulatory and (1) bed ridden. The LPA toured the facility visit and was assisted by applicant Tina Cinco during the post-license inspection. Structure: Facility residential single-story house has (5) bedrooms (4 resident bedrooms and 1 staff room), two (2) bathrooms, with a two (2) car attached garage/ storage/ laundry area. The facility is a beige stucco house structure with an open floor plan which includes living/ family, dining room and kitchen. The dining area has a fireplace. The living room area includes sofas, TV, side and coffee tables. The kitchen has quartz counter tops with a refrigerator, stove and dishwasher. During the visit, LPA noticed passageways, ramps and patio area free from obstruction. LPA observed a covered front porch area with seating for (2) people, and a backyard patio cover with table and six chairs, and a backyard grass golf putting green with holes. Bedrooms Residents: The facility has four (4) bedrooms for residents. All resident rooms have one (1) chair, one (1) bed, one (1) nightstand, and one (1) table lamp for each resident. The facility has central heat conditioning, and each room has a stationed air conditioner. All rooms have a dresser, which complies with the requirement of 8 cubic feet of space. All rooms also have closets for ample storage. Continued on LIC 809C Appliances: Stove burners, oven, microwave, washer, and dryer are working. Dishwasher in kitchen properly installed and functioning. The kitchen counters also have small appliances which includes: rice cooker, blender, toaster, coffee maker, and microwave. There is one (1) refrigerator in the home, and (1) backup in the garage. The refrigerator has a measured temperature of at least 45 degrees Fahrenheit for appropriate food storage. Freezer is at (45) zero degrees Fahrenheit. Refrigerator and pantry have required 2-day perishable, and 7-day non-perishable food. Toxins: All toxins are locked/stored under the kitchen sink. Water Temperature: Bathroom #1 hot water temperature was tested by LPA at 10:50 a.m. and measured at 106.6 degrees Fahrenheit, and bathroom #2 hot water temperature was tested by LPA at 10:55 a.m. and measured at 106.2 degrees Fahrenheit. Medications, First-Aid Kit & Book: A first aid kit stored in the dining room cabinet was inspected and has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual locked and inaccessible to residents in the living room cabinet. Also, resident medications will be stored in a dining room cabinet locked and inaccessible to residents. Resident & Staff Files: Applicant will not be handling cash for the residents. Files for residents and staff will be stored and locked in a cabinet located in the dining room. Reading Material, Games, Equipment & Materials: The facility has board games, books, magazines and other recreational materials for the resident's use all stored in the living/ family room cabinet, commensurate with the plan of operation. Pool/Jacuzzi & Pets: There are no pets, jacuzzi or pool in property. Continued on LIC 809C Fire Clearance: Fire Clearance conducted on 12/17/2021 for a capacity for six (6) residents with 5 non-ambulatory, and 1 bedridden. Gate on each side of the facility property with no locks. All smoke/ carbon monoxide detectors are connected, and are hardwired in the facility. The facility has six smoke/ carbon monoxide detectors, and two fire extinguishers. The facility has a fire alarm bell pull station in the hallway. All exit doors and slide doors, in the facility, have alarms, that signal when they are opened. Component III: LPA / Campos conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance. An exit interview was conducted, and a copy of this report has been furnished to the applicant, Tina Cinco . Accordingly, LPA/ Campos will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.