Pre-licensing visit·December 22, 2025

Licensing Program Analyst (LPA), Regina Cloyd, conducted an announced visit to the facility for purpose of a prelicensing evaluation. An application was received by CCLD on 07/02/2025, for Initial license for a Residential Care Facility for the Elderly to serve the Elderly for 60 years and older. The requested capacity is for six residents, of which two may be ambulatory and four non-ambulatory. Structure: Facility is a four bedroom, two full bathrooms, one shower room, one restroom, and one laundry room in a single-story house. There is a front porch, driveway, and backyard with patio furniture. This facility shares the lot, driveway, and exits with another property address. Bedrooms Residents: Bedrooms #1 is a shared room for ambulatory residents only. Bedroom #2 - #3 are shared rooms for non-ambulatory residents. Bedroom #4 is designated for the caregiver. Room #1 has two beds, two chairs, two nightstands/dressers, and two lamps in addition to overhead lighting. Continue to LIC809-C. There is one dresser with six drawers and one closet. Bedrooms #2 - #4 are currently set up as private rooms. Bathrooms: Both bathrooms, restrooms, and shower rooms are operable. Bedroom #3 has a private full bathroom. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored is stored in living room cabinets. Emergency Phone Numbers, Exit Plan & Menu: The facility has a working landline. There are two fire extinguishers located in the kitchen and hallway. Food Service: Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked cupboard. Dishwasher in kitchen properly installed and functioning. Smoke Detectors & Carbon Monoxide Detector: Operable & connected. Appliances: Stove burners, oven, microwave, washer, and dryer working. There is one refrigerator in the kitchen at a measured temperature of at least 40 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. The residence is equipped with central air and heat. Continue to LIC809-C. Toxins: Locked/stored. Water Temperature: Tested at 109.6 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 current first aid manual, which are stored at the front door entry. Reading Material, Games, Equipment & Materials: The facility has board games and puzzles for the residents' use, commensurate with the plan of operation. Pool/Jacuzzi & Pets: None. Fire clearance: Fire Clearance with the following special conditions: rooms approved for non-ambulatory/bedridden, approval of delayed egress or delayed egress with secured (locked) perimeter was approved on 12/08/2025. 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. Continue to LIC809-C. 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.