Pre-licensing visit·April 8, 2021

Licensing Program Analysts (LPA) Pauline Beschorner conducted an announced pre-licensing inspection to the facility via Microsoft Teams. LPA met with Licensee/Administrator Zina Clark and her son Theodore Stan. Due to the license being a change of location, LPA met with Licensee/Administrator at the Scarborough Way address on 4/7/2021. LPA verified the furniture being moved into the facility was present. LPA observed 6 beds, 6 night stands, 6 chairs, 6 dressers and 6 lamps that will be moved into the new facility. LPA also observed a dining room table, dishes and food in the refrigerator and the pantry. The facility currently has linens, towels and a sufficient amount of hygiene products for residents. LPA observed a completed first aid kit with a first aid manual. LPA also observed a charged fire extinguisher. In the backyard there was a chair with a table and an umbrella for the residents comfort outside which will also be moved to the new location. On 4/8/2021 LPA met with Licensee/Administrator Zina Clark and her son Theodore Stan. During this pre-licensing inspection, LPA also conducted the Component III. Currently the home is being used by the Mr. Stan. The home is a three bedroom, two bath home with a living room, dining room and kitchen. Per the approved fire clearance, the licensee is approved for 6 Non-ambulatory residents. The bathrooms were inspected to have grab bars and non-skid mats/flooring installed for resident safety. The water temperature was tested and measured at 110 degrees Fahrenheit. A centralized smoke detector was observed and operable. The facility has a carbon monoxide alarm installed and operable. LPA observed the locked closet in which the medications will be kept. LPA observed the knives and cleaners will be locked in the garage. The backyard has a large patio cover with chairs and a table for the residence comfort. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee/Administrator Zina Clark via email.