Pre-licensing visit·October 2, 2023

On 10/02/2023, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an announced pre-licensing visit to this home. LPA was greeted by applicant Brandi Brooks and explained the purpose of today’s visit. LPA was given access to the facility. An application was submitted to CCLD on 07/01/2023 for a change of facility type from Adult Residential Facility to Residential Care Facility for the Elderly. The applicant requested a capacity of four (4) individuals, of which maybe four (4) non-ambulatory, and one (0) bedridden. Structure: The home is a two (2) bedroom, one (1) bathroom, one story home with detached garage situated in a residential neighborhood. The home includes a living, dining, kitchen, and laundry area. Living room fireplace was completely covered. The living area included sectional seating. The kitchen has a refrigerator and stove. Passageways, walkways, and steps inside and out are free from obstructions. Bedrooms Residents: The facility has two (2) bedrooms for residents, which had two beds, two chairs and two bedside tables. Both bedrooms are equipped with ceiling lights and dressers, which comply with the requirement of 8 cubic feet of space. All rooms had closets for ample storage. Bathrooms: The home has one (1) bathroom. Bathroom has a working toilet, washbasin, and shower with grab bars and non-skid mats. Continued on LIC809-C 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 two (2) fire extinguishers located in the kitchen and hallway mounted on the wall. Facility has a working telephone. Emergency supplies and Personal Protective Equipment supplies are stored in the garage. The applicant has an approved Infection Control Plan on file. 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 kitchen drawer. Food supply is adequately stored and consist of (2) day supply of perishables and a (7) day supply of non-perishables. Smoke Detectors : Smoke and carbon monoxide detectors throughout the interior space. Smoke detectors in two (2) bedrooms and hallways. Carbon monoxide detector is in hallway. Toxins: All toxins are locked and stored in hall closet, with a locked space under kitchen sink available as well. Appliances: Kitchen appliances found to be within title 22 requirements. Home is equipped with central heaters and air conditioning systems. Water Temperature: The water temperature was found to be withing title 22 regulations throughout the kitchen and bathrooms. Medications, First-Aid Kit & Book: A first aid kit contained thermometer, tweezers, scissors, antiseptic, bandages, gauze, and current first aid manual locked and inaccessible to residents. The resident's medications will be stored in a cabinet locked in the laundry room and inaccessible to residents. Resident & Staff Files: Records of staff and residents will be stored in cabinets off in the laundry room area. Pool/Jacuzzi & Pets: There are no pets, jacuzzi, or pool on premises. A Fire Clearance inspection was conducted on 05/30/2023 and approved for a capacity for four (4) non-ambulatory and zero (0) for bedridden. Component III Orientation: Component III was completed with the Applicant during the Pre-Licensing visit. Information was provided about how to operate the facility within substantial compliance. When the applicant was asked if she understood Title 22 Regulations she responded in the affirmative. An exit interview was conducted, and a copy of this report will be emailed to aplicant Brandi Brooks. LPA Gonzalez 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 CAB Analyst assigned to their application.