Pre-licensing visit·March 4, 2025

Licensing Program Analyst (LPA) Kathleen Banrasavong conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. LPA met with Administrator, Vanessa Cyprian. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 09/30/2024 for a total capacity of four (4) residents. Fire clearance was granted on 11/22/2024. LPA Kathleen Banrasavong observed the following: Structure: The structure is two story house but the 1st floor in the facility is where the residents would be living. There are two (2) residents’ bedrooms, three (2) staff bedrooms, one (1) residents’ bathroom, two (2) staff bathroom, living room, dining area and kitchen. There was a separate two (2) car garage. There is not a pool. Heating/Cooling System: Central heating and air conditioning system are installed and operable. Temperature was set at 74 degrees. Bedrooms: Each resident bedroom #1, #2 were in good repair. Two (2) bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and eight (8) operable dual smoke and carbon monoxide alarms. Bathrooms: One (1) residents’ bathrooms have a working toilet, wash basin, and shower with an adequate supply of paper towels, toilet paper, and hand soap dispensers. LPA tested the water temperatures in the resident bathrooms. LPA verified water temperature was measured at 105 degrees Fahrenheit. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp drawer will be secured in a locked drawer located in the cabinet in the kitchen. There was adequate room for food storage. LPA observed the stove and microwave to be operational. Refrigerator/freezer were in working condition. Pantry had sufficient storage for non-perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was in the closet adjacent to the living room. Laundry detergents and cleaning supplies were observed in the laundry room closet. Living/Family room: There was a living room with furniture for all clients. Linens and Hygiene Supplies: An adequate supply of linens and hygiene supplies was stored in a cabinet in the hallway of the residence. Yards/Outside: Patio table and chairs were observed in the front yard. There was a gate on the northeast side of the facility and the entry to the driveway with a self-latching closure. Emergency Phone Numbers, and Exit Plan: Facility sketches were observed posted at the exits in the house. Exit signage, Let-Us-No poster, Rights of Resident Council, Theft & Loss, Personal rights, Non-discrimination observed. General items: Two (2) fire extinguishers were charged and located throughout the facility with signage; fire extinguisher were purchased on 09/04/2024. Client records will be stored in a locked cabinet. One (1) first aid kits with required components were observed. There was a locked area for medication storage. Emergency food and water supply was observed. Pre-Licensing is complete, and this facility has Pre-Licensing is complete, and this facility has zero (0) deficiencies that need to be corrected. An exit interview was conducted and a copy of this report was provided to the Administrator, Vanessa Cyprian.