Pre-licensing visit·January 23, 2026

Licensing Program Analyst (LPA), Regina Cloyd, conducted an announced visit to the facility for purpose of a Prelicensing evaluation. An application was submitted to CCLD on 08/14/2025, for a change of ownership for a Residential Care Facility for the Elderly to serve residents age range 60 and over. The facility is approved for six non-ambulatory residents of which one may be bedridden. It has an approved hospice waiver for six residents. Structure: Facility is a five (5) bedroom and two and one-half (2 ½ ) bathrooms, single story house with a detached garage. There are covered front and back patios with furniture. Bedrooms: Bedrooms 1 – 3 are approved for non-ambulatory/bedridden residents (fire sprinklers are required for more than one bedridden resident). Bedrooms 1 and 3 are currently set up as shared rooms. Continue to LIC809-C. Bedrooms 2 and 4 are private. All bedrooms have the appropriate number of beds, chairs, nightstands/dressers, and lamps in addition to overhead lighting. One bedroom is reserved for staff. Bathrooms: Both bathrooms have a working toilet, wash basin, and step-in shower. Bathrooms will accommodate non-ambulatory residents in a wheelchair. The half bathroom is used for staff. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored the laundry room. Emergency Phone Numbers, Exit Plan & Menu: The facility has a working landline. There are two fire extinguishers located in the kitchen and dining room area. Food Service: Dishes, cups and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked drawer next to the sink. Food supply adequate stored in the cabinets and refrigerator and consists of the following: canned goods, fruit, meat, and vegetables. Dishwasher in kitchen properly installed and functioning. Cont. Smoke Detectors & Carbon Monoxide Detector: Electrical & connected. Appliances: Stove burners, oven, microwave, washer, and dryer working. There is one refrigerator in the kitchen and in the garage. Each refrigerator has 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 heating. Toxins: Locked/stored in hallway cabinets. Water Temperature: Tested at 117.8 degrees Fahrenheit. 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 in the medicine cabinet, available for staff use but inaccessible to residents. Reading Material, Games, Equipment & Materials: The facility has board games and puzzles for the residents' use, commensurate with the plan of operation. Continue to LIC809-C. 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 08/19/2025. Rooms 1, 2, 3 are approved for bedridden/non-ambulatory. More than one bedridden client requires fire sprinklers. Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance. 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.