Pre-licensing visit·July 2, 2024

On 07/20/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted announced visit to this home. LPA was greeted by applicant Antonia Dionisio and explained the purpose of today’s pre-licensing inspection visit. An application was submitted to CCLD on 04/02/23 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 maybe two (2) non-ambulatory, three (3) ambulatory, and one (1) bedridden. Structure: The home consists of five (5) bedrooms, (1) staff bedroom, two (2) bathrooms, (1) staff bathroom a one story home with a one (1) car garage situated in a residential neighborhood. The home includes a living, dining, kitchen, and laundry area. The living room did not include a fireplace. The living area included recliner seating. 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 two (2) bedrooms for non-ambulatory, three (3) bedrooms for ambulatory residents and one (1) bedroom specific for the bedridden. All rooms include a twin-size bed, one (1) chair, one (1) night stand, 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. The room also included wall night lights. Evaluation Report Continues Bedrooms Staff: Bedroom #6 is 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 in the kitchen mounted on the wall. A telephone line is available in the kitchen, living, and dining rooms. Emergency supplies and Personal Protective Equipment supplies are stored in the garage. The applicant as 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 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 six (6) bedrooms and hallways. Carbon monoxide is in the living room area. Toxins: All toxins are locked and stored under the kitchen sink cabinet. Evaluation Report Continues Appliances: Stove burners, oven, microwave, washer, and dryer are working. The kitchen counters also had small appliances which includes toaster, air fryer, built-in microwave oven, and coffee maker. There is one (1) refrigerator in the home. The refrigerator measured a temperature of at least 40 degrees Fahrenheit for appropriate food storage. The home with electric fans and heaters. The living area has a cooling/heating split system. Water Temperature: The water temperature is 115.8 degrees F. 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 a mental cabinet locked in the dining room area and inaccessible to residents. Resident & Staff Files: The applicant is not handling the cash resources for residents. Records of staff and residents will be stored in a metal cabinet in the dining room 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 living 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 05/15/24 approved for a capacity for two (2) non-ambulatory, one (3) for ambulatory, and one (1) 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 PowerPoint. LPA Dabuet observed the following corrections: · Bedroom #1 is missing a window screen - corrected 07/03/24 · Bedroom #2 window screen has a small hole and will need to be replaced or repaired - corrected 07/03/24 · Bedroom #2 closet doors missing for privacy - corrected 07/02/24 · Outdoor furniture missing an outdoor umbrella - corrected 07/02/24 · Exterior gate missing an emergency latch release - corrected 07/02/24 An exit interview was conducted, and a copy of this report has been furnished to the applicant Antonia Dionisio. 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