Pre-licensing visit·November 1, 2023

Licensing Program Analyst (LPA) Amy Goldenberg conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. An initial application to operate a Residential Care Facility for the Elderly was submitted to the Central Applications Unit (CAU) on 06/20/2023 for a total capacity of 5 non-ambulatory and one bedridden resident. Fire Clearance was granted 07/19/2023. LPA Goldenberg observed the following: Structure: Facility was a single story house with four (4) resident bedrooms, two and one half bathrooms, living room, dining area, and kitchen area. Heating/Cooling System: Central heating and air conditioning systems. Bedrooms: All bedrooms were adequately furnished with bed, chair, large closets, appropriate linens, adequate lighting, and an operational smoke alarm. Bathrooms: Bathrooms have a working toilet, wash basin, and shower with an adequate supply of towels, toilet paper, and toiletries. Water temperature measured by LPA and thermometer read by LPA at 118 F. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Cleaning supplies and knives/sharp instruments were secured in a locked cabinet. There was adequate room for food storage. Refrigerator/freezer were in working condition and had sufficient storage for perishable food. There was adequate seating for meals. Living/Family room: Furnished with safe and adequate seating and furnishings. All items appear to be in good repair. Yards/Outside: The back was completed was a patio with adequate covered area for providing shade. There were no obstructions. There were no bodies of water observed anywhere on the property. Garage: Garage was organized and free of obstructions. Emergency Phone Numbers, and Exit Plan: Let-Us-No poster and clients rights are posted. General items: The facility has smoke and carbon monoxide detectors. These were tested and remain operational. LPA observed a facility phone and it was verified to be operational by LPA. COMPONENT III with the applicant was conducted during this Pre Licensing Inspection. This facility physical plant is prepared for licensure at this time. A copy of this report was reviewed with and provided to the applicant.