Facility Evaluation Report

On this date, October 25, 2024, Licensing Program Analyst (LPA) K. Nguyen and P. Manalo conducted a pre-licensing inspection, and met with LJ Jennings, applicant. License application is for six (6) total capacity all are 6 are ambulatory. Fire clearance was granted on June 27, 2024.

LPA toured the facility with the applicant. Physical plant is consistent with the facility sketches submitted to Centralized Application Bureau (CAB). There is no body of water. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Supplies of towels, bed sheets, linens were adequate. Equipment and supplies for residents' personal hygiene were available and on site. Food supplies were observed adequate for seven days of non-perishables. Facility is equipped with refrigerator, microwave, dishwasher, washer and dryer. Storage where knives and medications will be centrally stored was observed with lock. Complaint and Personal Rights posters were observed posted in prominent place. Facility land line telephone was tested and observed operational.

Fire extinguisher checked, observed fully charge with tag showed serviced January 23, 2024. First aid kit checked and observed complete with manual. Hot water temperature was tested in one of the common bathrooms and measured at 100.3 degrees Fahrenheit. Carbon monoxide and smoke detectors were tested and observed operational.

LPAs will inform CAB that this license is ready to be license.

Exit interview conducted and copy of this report provided.