Pre-licensing visit·June 9, 2025

On June 9, 2025 Licensing Program Analyst (LPA), Deborah Lee conducted an announced visit to the facility for the purpose of conducting a pre-licensing evaluation. An application was submitted to CCLD, for opening a new Residential Care Facility for the Elderly (RCFE). Fire clearance approved on September 26, 2024. LPA met with Denise Cuthkelvin, Applicant and explained the purpose of today’s visit. LPA and Applicant toured the physical plant(inside and outside). Overview of Facility: Facility is a single-story home located in a residential neighborhood. Entry way of the home is clear and free of debris and obstruction. There are 4 resident bedrooms, 3 bathrooms, living/common room, formal dining room, kitchen and attached garage that houses the washer and dryer. The Resident's bedrooms are spacious and easily accommodate the resident furnish ings. LPA observed that there are no bodies of water on the premises. The shaded area and outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPA did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility Page 1 of 3 Client Bedrooms: Bedrooms 1-4 have working lights, working windows with no bars. There will be 2 private rooms and 2 shared room. Bathrooms: All Bathrooms have a working toilet, wash basins and shower, and observed to be clean, safe, and sanitary. LPA observed adequate lighting throughout the entire facility. Linens & Hygiene Supplies: Extra linens are available to residents when need. Living/common room is fully furnished with sofa 2 chairs, mounted TV, and covered fireplace. Kitchen is clean and sanitary with a 4 seated counter/bar area. LPA observed a 7-day supply of non-perishables and 2 day supply of perishable. LPA observed area where sharps will be locked and inaccessible to the Residents in care. The formal dining area is equipped with a 6 seated dinning set. Facility has a lanline phone for emergencies. There are 2 fully charged fire Extinguishers located in the kitchen area and garage areas of the home. LPA observed all required postings: See something say something, resident rights, resident counsel, emergency disaster plan, facility sketch and exit signs. Smoke Detectors: Facility smoke detectors/carbon monoxide detectors are hardwired and interconnected. They were tested and operable. Appliances: LPA observed all kitchen appliances and washer and dryer in working order The residence is equipped with heat and air conditioning. Toxins: Applicant showed LPA, where toxins to be locked/stored. Page 2 of 3 Water Temperature: Tested at 108.6 degrees F. Resident & Staff Files : Resident and staff files will all be stored in locked closet located in a hall closet. There are no corrections needed. Component III: Conducted during today’s Pre-Licensing visit. A copy of report provided to applicant. Page 3 of 3