Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an announced pre-licensing inspection. Applicant is applying for Residential Care for Elderly to serve residents for age 60 and above. This is an initial application. LPA met with Tiffany Vander Poorten, applicant/ administrator. The requested capacity is six (6). No resident at the time of visit. Facility has an approved Dementia Care Plan. Hospice waiver is approved for six (6).

Fire clearance was granted on 08/01/24 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 operable. Bedroom#1 and #2 are approved for one (1) non- ambulatory in each room. Bedroom #3 and #4 are approved for two (2) non- ambulatory in each room. Garage in not approved for residents or staff residence.

The property is a single-family residence located in a neighborhood, consisting of four (4) bedrooms, two (2) full bathrooms, one (1) half bathroom, kitchen, dining room/living room with TV, laundry room, family room, administrator are at the kitchen, and detached garage. Passageways, walkways and patios are free from obstructions. The entrance and side areas are free of hazards and debris. 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.