Pre-licensing visit·March 10, 2022

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 01/06/22 for a total capacity of 6 non-ambulatory residents. Fire Clearance was granted 02/03/2022. LPA Goldenberg observed the following: Structure: Facility was a single story house with four (4) resident bedrooms, two bathrooms, living room areas, 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 at 108.3 degrees F. Kitchen: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Cleaning supplies and knives/sharp instruments were secured in a locked cabinet and drawer. 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. Linens and Hygiene Supplies: An adequate supply of back up linens are available. Yards/Outside: A large umbrella is provided for shade. Adequate outdoor seating is present. There were no obstructions to walkways. There were no bodies of water observed anywhere on the property. Garage: Laundry area with washer and dryer were located just inside the house near the garage exit. Laundry detergents and cleaning solutions are to be secured behind the locked garage door. Garage was organized and free of obstructions. Emergency Phone Numbers, and Exit Plan: Let-Us-No poster, and clients rights are available prominently for resident review. General items: The facility has 6 Smoke alarms and 1 carbon monoxide detectors. These were tested and operational. LPA observed a facility phone and it was verified to be operational by LPA. COMPONENT III was reviewed with the applicant during this Pre-Licensing Inspection. This facility meets the requirements for licensure. Applicant was provided with a copy of this report during the exit interview.