Pre-licensing visit·February 28, 2024

On 02/28/2024 12:52 PM, Licensing Program Analyst (LPA) Regina Cloyd conducted an announced visit to the facility for purpose of a pre-licensing evaluation. An application was submitted to CCLD on 11/15/2023, for an initial license for a Residential Care Facility for the Elderly to serve the elderly for ages 60 years and older. The requested capacity is for five (5) ambulatory only. The facility has a hospice waiver for three (3). Structure: Facility is a (4) bedroom, (2) bathroom, single story house with a (2) car attached garage. The facility has a kitchen, dining room, and living room. The home has a fireplace in the dining room with a metal screen cover and is inaccessible to residents. The residents' bedrooms are spacious and easily accommodate the residents' furnishings. There is a back yard with outdoor furniture and shade and a shed for storage. Passageways, walkways, driveways, steps and backyard are free from obstructions and hazards. Bedrooms: There shall be no more than two residents per bedroom. Bedrooms #1, #2, and #4 is for (1) ambulatory resident. Bedroom #3 is for (2) ambulatory residents. Bedroom #3 has two beds, two chairs, two night stands (with two drawers), and two lamps in addition to overhead lighting. It also has one dresser with five drawers and two closets. Bathrooms: All bathrooms have a working toilet, wash basin, and bathtub/shower. Night lights are in the hallways for bathroom #2. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen is stored in hallway closet. Continue to LIC 809-C Emergency Phone Numbers, Exit Plan & Menu: The Emergency Disaster Plan is posted & readily available for review on the cork board near the front door. Mounted fire extinguisher is located in the kitchen. The facility has a working landline. Food Service: Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good condition. Knives, cutlery and other sharp kitchen utensils are stored in a locked box in the locked island cupboard. Dishwasher in kitchen properly installed and functioning. Smoke Detectors: Smoke detectors and carbon monoxides are electrical, connected, and operable. Appliances: Stove burners, oven, microwave, washer, and dryer are working. There is one refrigerator in the kitchen. Refrigerator has a measured temperature of 41 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. The residence is equipped with central heating and one thermostat in the dining room. Toxins: Clearing compounds are locked/stored under the kitchen sink and in the garage. Water Temperature: Water temperature tested at 120 degrees. Medications, First-Aid Kit & Book: A first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and first aid manual, which are stored in the kitchen, available for staff use but inaccessible to residents. Medication boxes are also stored in the same area. Clients & Staff Files : Applicant has a surety bond for $1,000 to handle cash resources of residents and, cash resources will be locked and stored with P & I Ledger, accessible to designated staff. Records of staff and residents will be stored in a locked cabinet.. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the residents' use, commensurate with the plan of operation. Continue to LIC 809-C. Pool/Jacuzzi & Pets: No bodies of water, pool, jacuzzi, nor pets observed on the property. Fire clearance: Fire Clearance was approved on 01/09/2024. There are no security bars on the windows. Pre-licensing Checklist: Completed by licensee and reviewed by LPA. Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance. An exit interview was conducted and a copy of this report has been furnished to the applicant. Accordingly, LPA 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