Pre-licensing visit·March 16, 2022

Licensing Program Analyst (LPA) Jenifer Tirre visited this facility for the purpose of conducting a Pre-Licensing evaluation. Facility is a single story residential home. LPA along with Administrator Daniel Datcu toured facility at 2:10 PM and observed the following: Fire clearance approval was received on 01/11/22. Structure: Facility is a one story, 7 bedroom (6 Residents bedrooms and 1 staff bedroom) 4 bathroom house with attached garage and a beige exterior. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: All Residents bedrooms meet Licensing requirements. Bathrooms: All resident bathrooms have a working toilet, wash basin, and bathtub/shower as well as grab bars and non-skid surface in the shower. Linens & Hygiene Supplies: Facility has adequate supply of linens and towels. Emergency Phone Numbers and Exit Plan: Facility has Emergency Plan and Facility sketch posted on wall. Food Service: Facility has 2 day perishables as well as 7 day non-perishables in the pantry/ refrigerator, as well as emergency food and water supply. Smoke Detectors: Smoke detectors and carbon monoxide detector are centrally wired and were tested operational. Fire extinguisher is mounted and charged. Facility has 2 extinguishers. Facility has audible alarms on all entrance/exit doors. Appliances: Electric Stove and refrigerator are operational. Toxins : LPA observed toxins secured in locked storage area.. Water Temperature: Tested and recorded between 108.3 and 120.0 degrees F. in facility bathrooms. Reading Material Games, and Equipment: facility does exercises, coloring books and card games. Medications, First-Aid Kit & Book: Facility has first aid kit present at the facility. Facility has a secured location for medications and facility files. Backyard: LPA observed the facility perimeter is secured by wall with a self latching gate on both sides of facility as required. LPA observed shaded outdoor seating. CONTINUED ON 809C Administrator's Certificate observed on wall expiring March 12, 2024 Component III Orientation was waived during this pre-licensing visit due to Administrator presently operating other licensed facility. No deficiencies noted during todays visit. The pre-licensing visit has been completed. This location is ready for licensure. An exit interview was conducted with Administrator/ Licensee Daniel Datcu and a copy of report was left at facility.