Facility Evaluation Report

On 05/15/25 at 11:30AM, Licensing Program Analyst (LPA) D Panilio arrived to conduct an unannounced pre-licensing inspection. LPA met with Administrator/applicant (ADM) and explained the purpose of the visit. This is a change of ownership and facility currently has 5 residents. ADM has a current administrator certificate# 7012121740 which expires on 04/21/26. The facility received a fire clearance with an approval for 5 non-ambulatory residents and one bedridden resident in Room#5 on 11/10/24.

At 12PM, LPA toured the facility’s inside and outside areas. The facility is a 4-bedroom 21/2 bathroom one story house. There is one common bathroom located near bedrooms# 3, 4 and 5 and one full bathroom located in Room #2. Fire extinguisher was observed to be fully charged and last inspected on 07/24/24. Smoke detectors/Carbon Monoxide were tested and found operational.

At 12:15 PM, LPA observed a locked area for medications and First Aid kit in the kitchen area adjacent to the dining area. The laundry room contained locked cabinets for storing toxins, detergents and cleaning supplies. Beds were made with appropriate linens and additional linens were observed to be on hand in each closet. Furniture and lighting were observed to be safe and adequate. Each bedroom was furnished with a bed, bedding, a nightstand, a chair, and sufficient closet space. Hot water temperature in the resident bathrooms tested at 117 degrees Fahrenheit. Night lights were present in the hallways and bathrooms. There were no bodies of water present at the facility. Outside pathways to security exit gate were unobstructed. There was sufficient supply of both perishables and non-perishable foods. Proper hand-washing signs, Emergency/Disaster plans/contact information, personal rights were observed posted in common areas.

LPA observed no deficiencies during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.