Pre-licensing visit·December 18, 2024

On 12/18/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted announced visit to this home. LPA was greeted by applicants Genevieve Tan, Ediberto Bernardino and Joseph Sol and explained the purpose of today’s pre-licensing inspection visit. An application was submitted to CCLD on 04/05/24 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 five (5) non-ambulatory, and one (1) bedridden. Structure: The home is a three (3) bedroom, two (2) bathroom, one story home with a two (2) car garage situated in a residential neighborhood. The home includes a living, a dining, a kitchen, and a laundry area. The living room does not include a fireplace. The living area included recliners. 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 three (3) bedrooms for residents. There are two (2) bedrooms for shared non-ambulatory (1) of the bedrooms specific for the bedridden. All rooms include a twin-size bed, one (1) chair, one (1) nightstand, 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 LIC 809-C Bedrooms Staff: Bedroom #1 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 each bedroom. 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 extinguisher located in the kitchen mounted on the wall and in the garage. A telephone line is available in the living room. Emergency supplies and Personal Protective Equipment supplies are stored in the garage. The applicant submitted an approved Infection Control Plan. 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 four (4) bedrooms and hallways. Carbon monoxide is available in hallways. Toxins: All toxins are locked and stored under the kitchen sink cabinet. Evaluation Report Continues LIC 809-C Appliances: Stove burners, oven, microwave, washer, and dryer are working. The kitchen counters also had small appliances which includes a coffee maker, toaster, and Keurig. 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 is equipped with central heaters and individual air conditioning systems in each resident’s rooms. Water Temperature: The water temperature is 105.1. degrees throughout the kitchen and bathrooms. Medications, First-Aid Kit & Book: A first aid kit is stored in the kitchen 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 cabinet locked in the kitchen area and inaccessible. 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 activity 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 activity room. Pool/Jacuzzi & Pets: There are no pets, jacuzzi, or pool in the fenced area Evaluation Report Continues LIC 809-C A Fire Clearance inspection was conducted on 10/29/24 approved for a capacity for five (5) non-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. An exit interview was conducted, and a copy of this report has been furnished to the applicant, Ediberto Bernardino and Genevieve Tan. 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