Facility Evaluation Report

Licensing Program Analyst (LPA) Jill Clancy-Czuleger and Ardalan Gharachorloo, conducted an announced pre-licensing inspection. License application is for (6) total capacity, of which 0 maybe non-ambulatory. Fire clearance was granted on January 23,2024. LPAs met with Angeline Girgis (applicant-administrator).

LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPAs inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use.Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Outdoor activity space was observed furnished with tables, chairs and shade.

Fire extinguishers were observed fully charge. The two-in-one carbon monoxide and smoke detector tested and observed functional. First aid kit checked and observed complete with manual. Hot water temperature in one of the bathrooms tested and measured at 112.9 degrees Fahrenheit.

Facility did not have cash resource binder