Pre-licensing visit·June 13, 2024

Licensing Program Analyst (LPA) Kimberly Lyman made an announced visit to conduct a pre-licensing inspection. LPA identified herself and discussed the purpose of the visit with Administrator/ Licensee Alexander Arias. An initial application to operate a Residential Care Facility for the Elderly was received by CCL on 01/23/2024 for a capacity of six non-ambulatory residents. Facility has a screening area in the entrance of the facility. LPA Lyman along with Licensee/ Administrator toured the facility at 9:07 AM and observed the following: Structure: Facility is a one story, 4 bedroom, 2 bathroom house with a bonus room and an unattached garage and a tan exterior. The exit gates are closed, self latching, alarmed and unlocked. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: Rooms will be single and double occupancy. All rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Bathrooms: All resident bathrooms have a working toilet/ wash basin as well as grab bars and non-skid surface in the shower. Facility has sanitizer and paper towels in the restrooms. Linens & Hygiene Supplies: Facility has ample bedding and towels for residents in care. Emergency Phone Numbers and Exit Plan: Posted in the entrance of the facility. Food Service: Facility has 2 day perishables as well as 7 day non-perishables. Smoke Detectors: Smoke detectors/ carbon monoxide detectors are centrally wired and were tested operational. Fire extinguisher is mounted and charged. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins / Sharps : Facility has multiple secured areas for toxins and sharps. Water Temperature: Tested and recorded between 126.6 and 137.2 degrees F. in facility bathrooms. Emergency Supplies: LPA observed ample emergency food as well as a posted emergency disaster plan. Medications, First-Aid Kit & Book: First aid kit observed contained all required items. Medication is stored and locked in a locked cabinet. CONTINUED ON LIC 809C DATED 06/13/2024 Facility to use use a medication administration record. Resident & Staff File: Records are stored in a secured file cabinet in the kitchen. Reading Material, Games, and Equipment: LPA observed activities such as games and reading supplies. Facility provides exercise and music therapy.. Backyard : LPA observed a clean backyard with ample shaded seating for residents. Fire Clearance: Approved for six non-ambulatory residents on 04/12/2024. During the visit, LPA observed the following: Facility does not have fireplace screened. Please obtain a screen. There is not a working telephone on site. Please ensure there is a telephone. Facility does not have night lights in hallway. Please ensure night-lights are installed. Water temperature is out of compliance. Please adjust. Facility does not have ample emergency water. Please obtain additional water. Please post the "Let Us No" poster size 20" X 26" Please reconfigure bedroom 4 to ensure no doors are blocked and all required furnishings fit. Please obtain dressers for Component III conducted during the visit. Facility is not ready to be licensed. Licensee to contact LPA when corrections have been made. Exit interview conducted and a copy of this report was left at the facility.