Pre-licensing visit·May 19, 2023

On 5/19/2023 Licensing Program Analysts (LPA)/Alfonso Iniguez conducted a pre-licensing evaluation for an RCFE (Adult Residential Care Facility for the Elderly) facility type. Today’s pre-licensing evaluation was conducted with Sharina Hymes/Administrator. The licensee has applied for a license to serve (4) 60 years and over. The fire clearance is approved for (4) ambulatory Residents LPA toured facility Kitchen, Dining Room, Living Room, (2) Bedrooms, (1) Bathroom, Garage, Back Yard, and Patio with shaded area. LPA observed sufficient storage areas for kitchen supplies, linens, medications (secured) and chemicals (secured). LPA observed the following during this visit: MEDICATIONS There is a locked centralized storage area for Resident medications. PHYSICAL PLANT LPA observed the facility is clean, sanitary, and in good repair. Protective devices are in place. Indoor and outdoor passageways, stairways, open porches, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. Facility temperature is between 68°F. degrees and 85°F. degrees. Open porch, and areas of potential hazard are well-lit and equipped with sturdy hand railings. Carbon monoxide/Smoke detectors operate properly. Evaluation Report continues LIC 809-C BEDROOMS No client bedroom is a passageway to another room, bath, or toilet. There is a bed for each client with a mattress, mattress pad, bedsprings, and pillow(s) which are clean and in good repair. There is dresser and closet space for each client that includes at least two (2) drawers of dresser space per client. There is a chair and lamp for each client and at least one (1) nightstand per two (2) clients. BATHROOMS There is at least (1) toilets and washbasins per six (6) clients, family, and personnel. There is at least one (1) shower per ten (10) clients, family, and personnel. Hot water temperature is between 105°F.-120°F. degrees Fahrenheit. Bathroom is located near client bedrooms. Facility has enough nightlights in all hallways. SUPPLIES There are client personal hygiene supplies to include soap, toothpaste, toilet paper. There is a sufficient supply of clean linens to permit weekly changing or more of client top sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers, bath towels, hand towels, and washcloths. FOOD SERVICE Dining room is near kitchen. Refrigerator and freezer are clean and have the capacity to store at least two (2) days of perishable foods. There is storage for seven (7) day supply of non-perishable food. There are enough tableware, tables, dishes, and utensils. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean. RECORDS There is confidential storage for personnel records at the facility. There is storage for Resident confidential information and records at the facility. Evaluation Report continues LIC 809-C ADMINISTRATION The emergency exiting plan and emergency phone numbers are posted. Client Personal Rights are posted. Posting both sides of the Personal Rights form LIC 613 meets this requirement. Facility Visiting Policy is posted. Licensing Complaint Poster is posted. There is space available for resident council meetings and resident council postings. ACTIVITIES There is an outdoor activity space with a shaded area and furnished for outdoor use. There is at least one common room available to clients for visitors. Gardening will be part of the activities program. MISCELLANEOUS There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. There is an operating telephone available to clients. Emergency lighting and supplies to include flashlights with batteries. During the pre-licensing inspection, LPA found a correction is needed. the following items must be corrected, and proof of correction shall be submitted to the CCLD office. Observation: The garage is currently utilized as a living space. Correction needed: The garage will be utilized according to the facility sketch presented to CAU. An exit interview was conducted, and a hard copy of this report has been provided to the applicant. A copy of this facility evaluation report will be available 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 their assigned CAU Analyst.