Pre-licensing visit·September 4, 2025

Licensing Program Analyst (LPA) Mario Leon, conducted an announced visit to the facility for purpose of a pre-licensing evaluation. An application was submitted to CCLD on 10/21/24, for an an initial license for a Residential Care Facility for the Elderly to serve the Elderly for ages 60 and above. The requested capacity is for six (6) ambulatory of which one (1) may be bedridden. Structure: Facility is a (4) bedroom, (4) bathroom, single story house with an attached (2) car garage. The facility is a white wood-paneled structure with (4) bedroom, (4) bathrooms, 1 living room, a restaurant style kitchen. The home has a gas fire place in the living room with a metal screen cover, and is inaccessible to clients. There is a large backyard, with a shaded patio area with plentiful seating for residents in care and a front yard with stable. The client bedrooms are spacious and will easily accommodate the client's furnishings. All walkways are either ramped or gated and there have been no obstructions observed during today's visit. Bedrooms Residents: – Bedrooms approved for Ambulatory residents only shall not be used for Non-Ambulatory, per 85087. There shall be no more than two clients per bedroom. Bedrooms #1 are for bedridden residents . Bedroom #(3) and (4) has two beds, two chairs, two night stands, two lamps in addition to overhead lighting and fan. Each room has more than 8 cubic feet of storage per resident. Report continues see LIC809-C. Bedrooms Staff: Bedroom #5 is for live-in staff, with full-bath. No bedroom is designated for awake-staff. Bathrooms: All bathrooms have a working toilet, wash basin, and a shower. Bathroom between rooms #(2) and #(3) has one walk-in shower which will accommodate non-ambulatory residents in a wheelchair. Each full-bathroom has a slip-resistant bath mat and all bathrooms host sturdy grab bars. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, waterproof mattress pads, fitted sheet, draw sheet, and blanket. Bedspreads and ample linens are stored in the linen closet, located at the South-Western end of the house, closest to the stable. Emergency Phone Numbers, Exit Plan & Menu: The facilities telephone system is a landline and is in working condition. Posted & readily available for review in the entryway is the emergency disaster plan, which also displays emergency exit plan. Three (3) Fire Extinguishers are present in the facility with one (1) located near kitchen next to the fridge, one (1) in the entryway, and one (1) in the garage. Food Service: Dishes, cups and flatware are stored in the kitchen cupboards, have been inspected and are in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked drawer next to the sink. Food supply is adequately stored in kitchen cabinets and refrigerator. LPA observed at least a three (3) day perishable and seven (7) days non-perishable foods, adequately stored. There are three (3) twenty-five (25)-day emergency food is stored nearby the entrance and in the garage cabinet there is ample bottled water in case of emergency. Dishwasher in kitchen properly installed and in functioning condition. Smoke Detectors: Smoke and Carbon monoxide detectors located in each room and are hard-wired. The alarm system has been professionally installed and have been tested during today's visit. Appliances: Stove burners, oven, two (2) microwaves, washer, and dryer are in working condition. There is one refrigerator, measured at, at least, 45 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. The residence is equipped with central air and heat and each client bedroom is individually climate controlled. Report continues, see LIC809-C. Toxins: During today's visit, LPA observed all cleaning detergents were stored inaccessible to residents in care. There are no firearms located on the premises. Water Temperature: Water temperature was tested and remain within Title 22 regulations. 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 current first aid manual, which are stored under the kitchen island, available for staff use but inaccessible to clients. Clients & Staff Files : Records of staff and clients are stored in a locked cabinet underneath the kitchen island and are inaccessible to residents in care. Reading Material, Games, Equipment & Materials: The facility has board games, adult coloring books, painting easel and other recreational materials for the client's use, commensurate with the plan of operation. Pool/Jacuzzi & Pets: None present. Fire clearance: Fire Clearance was approved on 04/08/25 for 5 non-ambulatory and one (1) bedridden in bedroom number one #(1). All windows have appropriate release and there were no obstructions observed for a safe and quick egress during an emergency. Prelicensing Component III: During the prelicensing inspection, LPA presented component III and all staff present have acknowledged awareness. 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 Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.