Pre-licensing visit·June 1, 2021

Licensing Program Analyst (LPA) Shobhana Frank arrived to conducted an announced visit to the facility for purpose of a Pre-licensing/Comp III Visit. LPA was greeted at the door by Licensee Flormine Resurreccion granted entry and lead the tour of the facility indoors and outdoors. The following was observed: An initial application to operate Residential Care Facility for the Elderly, age 60 years and over, for (6) capacity, (6) non-ambulatory resident was submitted to CCL on 1/12/2021. structure: Facility is newly build a single story 6- bedrooms; 7 bathrooms house with an attached garage. The facility is equipped with a living room, dining area, office and activity area. LPA observed COVID - visitation station equipped with hand sanitizer, thermometer, visitors log. LPA observed COVID posters throughout the facility. LPA observe the facility to be clean and in good repair. Physical Plant and Safety of Environment/Operational Requirements Bedrooms Residents: Bedrooms are single occupancy. Each bedroom has attached bath room. All bathrooms have a working toilet, wash basin, grab bar, rolling shower, accommodates non-ambulatory clients in a wheel chair. Bathroom: One powder room Adequate supply of linens and hygiene supplies are stored in main hallway closet. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review in the kitchen Food Service: Adequate supply of 7- day non-perishable and 2- day perishables are stored in the kitchen. Kitchen was observed to be clean and in order. Sharps were observed to be kept in a locked closet. Report continue from 809 . Smoke Detectors: Smoke detectors which were operational, carbon monoxide detectors which were operational auditory device in each bedrooms and bathrooms are operable, facility has water fire sprinklers throughout the facility. Smoke detectors and carbon monoxide were tested. Fire clearance was granted on 5/25/2021 Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. The refrigerators and freezers were installed with the required thermostats. Toxins: Locked/stored in cabinet by the laundry room. Water Temperature: Tested and recorded at Bathroom : 110.2 degrees Fahrenheit. Medications, First-Aid Kit In kitchen stored in a locked by the kitchen cabinet. Back yard: Back yard with covered patio and without hazards, outdoor and indoor passageways are free of obstruction. Clients & Staff Files : Location: locked & located in cabinet in the kitchen cabinet. . Reading Material, Games, Equipment & Materials: The facility has purchased and will transfer board games, books, exercise periods, puzzles, art (coloring, sketching, etc.) and other recreational materials for the client's use locate by living room. There are no bodies of water located on premises. Facility has provided copy of Certificate of Liability Insurance - expires in 6/2021. Facility appears to be ready for licensure. LPA will complete the administrative process, and contact Licensee when the licensing procedure is completed. An exit interview was conducted and a copy of this report was provided.