Pre-licensing visit·June 3, 2024

On 06/03/2024, Licensing Program Analyst (LPA) Antonine Richard conducted an announced visit to the facility for the purpose of a pre licensing evaluation. LPA was greeted by applicant Tina Scruggs-Tate and explained the purpose of today’s pre-licensing inspection visit. An application was submitted to CCLD on 04/24/23 in the initial license application for a Residential Facility for the Elderly, ages 60 years and older. The applicant requested a capacity of four (4) individuals, of which two (2) non-ambulatory, and zero (0) bedridden. Structure: The home is three (3) bedrooms, two (2) bathrooms, one-story home situated in a residential neighborhood. The home includes a living, dining, kitchen, and laundry area. The living room had 6 chairs and coffee table. The activity room area with chase. The kitchen has a refrigerator and stove. The rear exterior is fenced throughout. The passageways, walkways, and steps are free from obstructions. LPA did not observe hazards, such as ladders, gardening tools. The patio contained one (1) table and four (4) chairs. Bedrooms Residents: The facility has three (3) bedrooms for residents. There is one (1) bedroom for non-ambulatory residents and two (2) of the bedrooms specific for the ambulatory. One room include two twin-size beds. The other two rooms include a full-size bed. one (1) chair, one (1) nightstand, one (1) trash ban with a lid, 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. Bathrooms: The home has two (2) 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 is one (1) fire extinguisher located by the laundry area. A telephone line is available in the kitchen, living, and activity rooms. Emergency supplies and Personal Protective Equipment supplies are stored in the cabinet. The applicant submitted a Mitigation Plan on 03/19/2024. 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 three (3) bedrooms and hallways. Carbon monoxide is combined with smoke detectors a total four (4). Toxins: All toxins are locked and stored in the hallway in locked cabinets. Evaluation Report Continues Stove burners, oven, microwave, washer, and dryer are working. The kitchen counters also had small appliances which include toaster, and microwave. 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 116.3F degrees throughout the kitchen and bathrooms. Medications, First-Aid Kit & Book: A first aid kit is stored in the living room 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 medication cabinet locked in the hallway and inaccessible. Resident & Staff Files: The applicant is handling the cash resources for residents. Records of staff and residents will be stored in the licensee office. 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 08/22/23 approved for a capacity for four (4) ambulatories and two (2) can be non-ambulatory, and zero (0) for bedridden. Pre-licensing Checklist: Completed by licensee and reviewed by LPA. Component III: LPA Richard Conducted the Pre-Licensing visit, along with the information provided about how to operate the facility within substantial compliance with Component III Power Point. No corrections observed. A copy of the report was provided to Licensee Tina Scruggs-Tate END OF REPORT