Pre-licensing visit·June 17, 2025

Licensing Program Analyst (LPA), Tiffany Holmes conducted an announced Pre-licensing inspection. An initial application to operate a Residential Care Facility for the Elderly was received on 03/10/2025. The facility was approved to care for four (4) Elderly Residents; LPA was greeted and allowed entry into the facility by and met with Dominque John, Applicant. Structure - The facility is a single story structure with 4 bedrooms and 3 bathrooms. There is an outdoor covered area for resident use. No bodies of water were observed. Bedrooms Residents - Rooms #1, #2, will be shared room for Non-Ambulatory clients Bedrooms Staff - 2 other rooms/1 for staff room and the other is an office Bathrooms - All bathrooms have a working toilet, sink, grab bars and tub/showers with non-skid mats. Linens & Hygiene Supplies - Adequate supply. Emergency Phone Numbers, Exit Plan and Required Postings - Posted. Smoke Detectors and Carbon Monoxide Detectors- Interconnected and hardwired. Appliances - Stove burners, oven, microwave, washer, and dryer working. Toxins - Stored in a locked cabinet. Water Temperature - Measured at 114.4 degrees F. Medications- Centrally stored and locked in a cabinet in the lounge area. First-Aid Kit - Stored in a locked cabinet. Resident & Staff Files - Located cabinet. Activities - Adequate supplies to include exercising, games and puzzles for resident's use. Fire clearance - Approved on 05/30/2025. Component III - Conducted at the Pre-Licensing visit. Information provided about how to operate the facility within substantial compliance. All items reviewed during the visit are in compliance. Pre-licensing is complete and this facility has no deficiencies. Facility appears to be ready for licensure pending final review. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Dominque John, Applicant signature below confirms receipt of these rights.