Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an announced pre-licensing inspection. This is an initial application applying for Residential Care for Elderly to serve residents for age 60 and above. LPA met with Gladys Pervez, applicant/ administrator. The requested capacity is six (6). No resident at the time of visit. The licensee is Elite Manor Inc. Facility has a Dementia Care program for six (6) residents. Hospice waiver was approved for five (5).

Fire clearance was granted on 01/25/23 for six (6) non-ambulatory and zero (0) bedridden. Fire clearance and Dementia care plan are in place. Auditory device is installed at all exits and operational.

The property is a single-family residence located in a neighborhood, consisting of three (3) bedrooms, two (2) bathrooms, kitchen, dining area, laundry room, detached garage, and living room with a TV. Passageways, walkways and patios are free from obstructions. The entrance and side areas are free of hazards and debris.

Facility does not have a signal system. Garage is not accessible to residents.

Bedrooms have nightstand, adequate lighting, adequate closet and drawer space. Bedrooms are spacious and allow for easy passage between and comfortable for usage. (- Continued LIC 809 C -)