Pre-licensing visit·May 10, 2022

On 05/10/22, Licensing Program Analyst (LPA) Ernand Dabuet conducted an announced visit to this home. LPA was greeted by applicant Terista Bautisa and Joel Morales and explained the purpose of today’s pre-licensing inspection visit. An application was submitted to CCLD on 01/11/22 in the initial license application for a Residential Facility for the Elderly, ages 60 years and above. The applicant requested a capacity of six (6) individuals, of which two (2) ambulatory, four (4) non-ambulatory, and zero (0) bedridden. Structure: The home is a five (5) bedroom, three (3) bathroom, one-story home with a two (2) car garage situated in a residential neighborhood. The home includes a living, dining, kitchen, and laundry area. The living room had sofa, chairs and coffee table. The activity room area with a fireplace included recliners. The kitchen has a refrigerator and stove. The rear exterior is fenced throughout. The passageways, walkways, and steps are free from obstructions. Bedrooms Residents: The facility had five (5) bedrooms for residents. There are three (3) bedrooms for non-ambulatory residents and two (2) of the bedrooms specific for the ambulatory. All rooms include a twin size bed, one (1) chair, one (1) nightstand, and one (1) table lamp. All bedrooms are equipped with a ceiling light. All rooms had a dresser, which complies with the requirement of 8 cubic feet of space. All rooms had closets for ample storage. Evaluation Report Continues Bedrooms Staff: There is no bedroom designated for live-in staff. There is a staff lounge area. Bathrooms: The home has three (3) bathrooms. Bathrooms are accessible in all rooms. All bathrooms have a working toilet, washbasin, and shower with grab bars and non-skid mats. Linens & Hygiene Supplies: Beds have the required linen supplies which include, pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. An adequate supply of linen is stored in the hall closet inside the bedrooms. Emergency Phone Numbers, Exit Plan & Menu: Emergency phone numbers. The exit plan and menu are posted and readily available for review throughout the home. There are three (3) fire extinguishers located throughout the home. A telephone line is available in the kitchen, living, and activity rooms. Emergency supplies and Personal Protective Equipment supplies are stored in the garage. The applicant submitted a Mitigation Plan on 01/20/22. Food Service: Dishes, cups, and flatware are stored in the kitchen cabinets, inspected, and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a locked drawer. Food supply is adequately stored in kitchen cabinets and consists of the can goods. The kitchen counters also had small appliances. Smoke Detectors: Smoke and carbon monoxide detectors throughout the interior space. Hardwired smoke detectors in all five (5) bedrooms and hallways. Carbon monoxide is combined with smoke detectors. Toxins: All toxins are locked and stored in the laundry room in locked cabinets. Evaluation Report Continues Stove burners, oven, microwave, washer, and dryer are working. The kitchen counters also had small appliances which include a air fryer, toaster, blender and coffee maker. There is one (1) refrigerator in the home. The refrigerator measured a temperature of at least 45 degrees Fahrenheit for appropriate food storage. The home is equipped with central heaters and air conditioning systems. Water Temperature: The water temperature is 116.0 degrees throughout the kitchen and bathrooms. Medications, First-Aid Kit & Book: A first aid kit is stored in the medication cabinet inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze, and current first aid manual locked and inaccessible to residents. The resident's medications will be stored in the same medication cabinet locked in the kitchen and inaccessible. Resident & Staff Files: The applicant is not handling the cash resources for residents. Records of staff and residents will be stored in a kitchen cabinet in the kitchen area. 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 activity room. Pool/Jacuzzi & Pets: There are no pets, jacuzzi, or pool in the fenced area. Evaluation Report Continues Fire clearance: A Fire Clearance inspection was conducted on 04/12/22 approved for a capacity for four (4) non-ambulatory, two (2) for ambulatory, and zero (0) for bedridden. Component III: LPA Dabuet conducted the Pre-Licensing inspection along with the information provided about how to operate the facility within substantial compliance with Component III Power Point. LPA observed no corrections during this pre-licensing inspection. An exit interview was conducted, and a copy of this report has been furnished to the applicant, Terista Bautista. LPA Dabuet 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. END OF REPORT