Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with the applicant representative/administrator, Lucy Perera. An Application to operate an Adult Residential Facility (ARF) was received by Community Care Licensing (CCL) on December 27, 2024. The facility is a one story building. A fire clearance was approved on March 7, 2025 for two (2) non-ambulatory residents and two (2) ambulatory residents, for a total capacity of four (4). The smoke alarms are hard-wired and interconnected. There are two functional carbon monoxide detectors located in the hallway by resident rooms. The facility has three fire extinguishers located by the kitchen, in the hallway and garage. Charge date for the fire extinguishers is November 10, 2024.

A tour of the physical plant was initiated at approximately 9:45am and the following was observed:

KITCHEN: The kitchen is equipped with a refrigerator, stove, oven, microwave and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of four (4). Knives are locked in a kitchen drawer. Cleaning supplies and laundry detergent will be kept in a locked closet.

BEDROOMS: There are five (5) bedrooms, of which four (4) are designated for client use. All four bedrooms designated for resident use are private. Per STD 850, rooms #1 and #2 have the fire-clearance for non-ambulatory, while room #4 and #5 are for ambulatory only. Room #3 is designated as staff office/workstation. The applicant furnished the resident bedrooms with beds, night stand, chairs, bedding and linen. The bedrooms have sufficient lighting and closet space.