Pre-licensing visit·January 30, 2026

On January 30, 2026, Licensing Program Analyst (LPA), Antonine Richard 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 Residential Care Facility for the Elderly (RCFE) on 11/14/2024. On December 02, 2025, the Fire clearance was approved for capacity of 6 residents 60 and over residents (6) ambulatory and (0) non-ambulatory). On January 30, 2026, LPA met with Tianah Johnson, Applicant and explained the purpose of today’s visit. LPA and Applicant toured the physical plant (inside and outside). Overview of Facility: Facility is one story home located in a residential neighborhood. Entry way of the home is clear and free of debris and obstruction. There are (3) resident rooms, 2 bathrooms, living/common room, dining room, kitchen, laundry room and detached garage which is outside in the backyard. The bedrooms are spacious and easily accommodate the residents' furnishings. Report Continued on LIC809C 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 obstruction. 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. Resident Bedrooms : Bedrooms 1-3 have working lights, working windows with no bars. There will be 3 shared rooms. 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. Lines & Hygiene Supplies : Extra linens are not available to residents when needed and located in residents bathrooms. Living/common room is fully furnished with 5 recliners, TV, and the fireplace. Dining area is equipped with a 6-seats dinette set. There is adequate space for the residents. Kitchen is clean and sanitary with appliances that are operational. LPA observed 7-day supply of non-perishables foods and 2-day supply of perishable food. LPA observed the area where sharp objects and cleaning solutions will be locked and inaccessible to the residents in care. Report Continued on LIC809-C The Facility has a landline phone for emergencies. There are 2 fully charged fire Extinguishers inside the home. LPA observed all required postings: See something say something, resident rights, emergency disaster plan, facility sketch and exit signs Resident/Staff files: LPA observed that there was a confidential storage area where staff and resident files will be kept it will be securely locked in a file cabinet. Medications: LPA observed that there is a locked centralized area where residents' medications will be stored. Located in locked cabinet near kitchen area. Smoke Detectors : Facility has 6 smoke detectors/carbon monoxide detectors are hardwired and interconnected. They were tested and operable. Water Temperature : Tested between 105-120 degrees F. There are five (5) corrections needed. The Licensee will email the corrections needed to LPA Richard on February 12, 2026. Component III: Conducted during today’s Pre-Licensing visit. A copy of this report was provided to the Licensee.