Pre-licensing visit·August 11, 2025

At approximately 9:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility announced, for the purpose of conducting a pre-licensing inspection and met with Applicant Samantha Ray. Fire Clearance has been approved for a capacity of 6 residents; 5 of which may be non-ambulatory and 1 of which are bedridden. The facility was also granted a hospice waiver capacity of 3. LPA conducted a tour and inspection of the indoor and outdoor portions of the facility. Facility was found to be clean and at a comfortable temperature with all doors and exits free from obstruction. There is a shaded outdoor seating area. Fire extinguishers found throughout the facility were charged and inspected within the last 12 months. Smoke detectors and carbon monoxide detectors in resident bedrooms and throughout the facility were tested and found to be operational. Exits of the facility and front entrance have appropriate auditory alarm systems and found to be functioning. Water temperature at faucets accessible to residents was measured and found to be within regulation, between 105 & 120 degrees F. There was an ample supply of fresh linens, continence care and hygiene products available. A tour of the kitchen and food supply was inspected and found to be clean and orderly. Food items were stored properly. Residents will be provided various nutritious meals with alternate options and snacks readily available upon request with a sufficient amount of food for the number of residents in care. Cleaning supplies, laundry products and other toxins were properly secured in designated storage closets. Medications will be centrally stored and secure. Facility has generator to supply power in case of emergency. The Emergency Disaster Plan was reviewed and shows appropriate evacuation sites. Licensee will send a copy of liability insurance to CCLD once Licensed. Component III orientation was conducted with the Applicant. The pre-licensing evaluation has been completed. License will be granted upon completion of a final review and approval from the Licensing Program Manager. This report was reviewed with applicant and a copy was provided.