Pre-licensing visit·May 18, 2022

Licensing Program Analyst (LPA) Bernadette Allen conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. I met with Administrator Jennifer Hanh. An initial application to operate an Residential Care Facility Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 3/14/2022 for a total capacity of six( 6) four (4) bedridden and two (2) non ambulatory. Fire clearance was granted on 04/14/2022. LPA Allen observed the following: Structure: Facility is a house with five (5) resident bedrooms, three(3) resident bathrooms, living room, dining area and kitchen. There was an attached two 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 a to control entire house. Bedrooms: Master bedroom and bedroom #3 can be used for bedridden only per fire clearance. All bedrooms including the master bedroom and bedroom #3 will accommodate bedridden resident and are adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, Bathrooms: All three (3) bathrooms have working toilets, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. The water temperature was measured at 118.0 degrees Fahrenheit. Kitchen/Laundry: The kitchen has adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen drawer next to sink. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. Kitchen.. There was sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was located near the garage. Laundry detergents and cleaning supplies were observed in closet near the garage secured in a locked closet.. Living/Family room: There was a living/family room with a TV and adequate seating for all clients. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outside: There is currently covered seating area in the front of the house and patio cover will be delivered on 5/19/2022 for backyard. There is a gate on the right side and left side of the property with a self-latching from the exterior doors. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch were observed posted in the main hallway. General items: There was fire extinguishers and carbon monoxide detectors are in good conditions. Client records will be stored in a locked cabinet in the family room area. First Aid kit with required components are located in kitchen drawer. Medication will be locked in a cabinet in living/dinning area. LPA observed a facility phone and it was verified to be operational . Emergency water supply and food was observed. An exit interview was conducted, and a copy of this report was given to the administrator Jennifer Hanh-Administrator