Pre-licensing visit·February 25, 2022

Licensing Program Analyst (LPA) Yolanda Delgado conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. At approximately 9:00 AM, LPA met with Licensee/Administrator Kristine Mangente. An initial application for Change of Ownership to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 9/23/21 for a total capacity of four (4) non-ambulatory and two (2) bedridden residents. Fire clearance was granted on 11/16/2021. LPA Delgado observed the following: Structure: Facility was a one-story house with five (5) resident bedrooms, two (2) resident bathrooms, living room, family room, dining area and kitchen. There was an attached one car garage in the front of the house. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control entire house. Bedrooms: Each resident bedroom #1, #2, #3 and #4 will accommodate any non-ambulatory resident, bedroom #5 will accommodate bedridden residents. 5 resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm. Bathrooms: The (2) resident bathrooms has a working toilet, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. At 9:41 AM, LPA tested the water temperatures in the resident bathrooms. LPA verified water temperature was measured at 106.3 degrees Fahrenheit. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. (CONTINUED ON LIC 809C) (CONTINUED FROM LIC 809) and had sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was located inside the garage. Laundry detergents and cleaning supplies were observed in garage away from residents. Living/Family room: There was a living/family room with for all clients and TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outside: Patio table and two chairs were observed in the backyard; more chairs are needed. There was a gate on the South side and North side of the property with a self-latching from the exterior doors that needs to be repaired. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch were observed posted in the main hallway. Obudsman poster and Let-Us-No poster observed. General items: One (1) fire extinguishers were charged and located in the kitchen. Seven (7) smoke alarms and one (1) carbon monoxide detectors were tested and were observed to be in working order except for one (1) in the living room. Client records will be stored in a locked cabinet in the Family room. First Aid kit with required components, and locked area for medication storage was observed. LPA observed a facility phone and it was verified to be operational as evidenced by LPA dialing the number to trigger a ring. Emergency water supply was not observed however the required 72-hour emergency food supply was not discernible from the regular food supply. Component III was completed on this day as well. (CONTINUED ON LIC 809C) (CONTINUED FROM LIC 809C) Pre-Licensing is incomplete and the following corrections to be resolved by 2/28/2022: obtain a separate 72-hour emergency food supply obtain separate emergency water obtain and post visiting policy obtain 30-Days of PPE supplies obtain additional patio chairs obtain auditory alarm for live-in staff quarters remove debris in the backyard repair smoke detector in the Living room An exit interview was conducted, and a copy of this report was given.