Facility Evaluation Report

At 10:40 a.m. on 12/06/2023, Licensing Program Analysts (LPAs) Nicholas Reed and Michael Cava conducted an announced prelicensing inspection. LPAs met with the applicant and administrator and disclosed the reason for the visit. LPAs, applicant, and administrator toured the facility inside and out at 10:50 a.m.. No immediate health and safety hazards were observed during this visit.

It is a single story building with four (04) bedrooms, two (02) bathrooms, kitchen. garage, common areas, and outdoor areas. It has an approved fire clearance for non-ambulatory residents in Bedroom #1 and Bedroom #3, a bedridden resident in Bedroom #2, and an ambulatory resident in Bedroom #4. Hospice waivers for 6 residents. The facility uses surveillance cameras in common areas and exterior areas.

At the main entrance, LPAs observed postings for personal rights, non-discrimination notice, administrator certificate, Ombudsman contact, complaint contact poster, and rights of resident councils. LPAs advised that the complaint poster must be 20” x 26”, and the facility should also post a blank copy of the admission agreement, visitation policy, emergency disaster plan, and a weekly menu. LPAs also observed facility sketches with evacuation procedures clearly labelled throughout the facility.

All emergency exit paths were free from obstructions. The rear exit gate was unlocked with a self-closing latch. The rear exit gate shall remained unlocked as per the facility’s fire clearance. Front gates were locked and approved by the city Fire Inspector. At 10:55 a.m., the carbon monoxide detector at the front was tested and operational. At 11:00 a.m. today, the smoke detector in Bedroom #1 was tested and operational. During the test, three (03) out of three (03) fire doors closed. At approximately 11:05 a.m. LPA observed fully charged fire extinguishers at the front and in the kitchen. They were last inspected on 11/16/2022. The applicant set a reinspection date for 12/07/2023. At 11:10 a.m. today, six (06) out of six (06) auditory alarms were heard on and functioning. At 11:15 a.m. LPAs tested the house phone to be operational.