Facility Evaluation Report

On 11/01/23 at 10AM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced pre-licensing visit and met with applicant. LPA explained the purpose of the visit with applicant.

Facility has an approved fire clearance dated 03/21/23 for 4 residents. There are 4 bedrooms and 2 bathrooms. Posters including but not limited to Covid-19 related posters, complaint poster, Personal Rights were observed. All bedrooms were observed furnished with a bed, dresser, closet, night-stand, lamp and chair. Hallways and passageways were free of obstruction. There was sufficient lighting and furniture. The kitchen was observed clean and organized. There was sufficient supply of non-perishable foods observed. Plates, silver wares and glass wares were observed available. A copy of menu was posted on the refrigerator. Hot water measured at 119 F. There was a locked cabinet for medicine and resident files. Knives and other sharp objects and chemicals were kept in a locked drawer and cabinets in the kitchen & garage. There was sufficient supply of towels, sheets, blankets and hygiene products observed.

Smoke detector and carbon monoxide were tested and observed operational. First aid kit was complete. There were activity materials available. Facility has a washer and dryer installed in the laundry room. LPA observed chairs and tables in the backyard with a covered porch for use of clients. There were no bodies of water observed.

LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Branch (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

Exit interview conducted and a copy of this report was provided to Applicant via email.