Facility Evaluation Report

Licensing Program Analyst (LPA) Ashley Calderon conducted an announced pre-licensing visit. LPA met with Applicant / Rona Lomeda for the purpose of conducting a pre-licensing inspection/ Component 3. A hospice waiver has been approved for a maximum of 6 terminally ill residents. Dementia plan of operation, Infection Control Plan and Bedridden plan was submitted to Centralized Application Bureau (CAB) Specialist and is/will be under review. The facility has an approved fire clearance for five (5) non-ambulatory residents and one (1) bedridden resident. Facility approved for total capacity of (6) six. The facility is a single story, five (5) bedroom, three (3) bathrooms (1 will be used for staff/visitors only), and has a detached garage. Home is located in a residential neighborhood in the City of Norwalk. Facility will be licensed to be a Residential Care for the Elderly, serving residents age range 60 and over.

-This facility was granted a fire clearance on 3/28/23.

-The physical plant was toured inside and out. At this time, LPA has determined that the home is ready and passed the pre-licensing inspection / Component 3.

-Facility tour alongside with Rona Lomeda / LPA used Pre-Licensed Inspection Tool.

-Night lights and emergency lights in place and maintained throughout the facility.

-Passageways, stairways and doors are free of obstructions.

-Signal system in place on all exit doors.

-Bedrooms #1- #4 approved for non-ambulatory and Bedroom #5 approved for Bedridden.

-Water temperature in bathrooms, measured between 105F - 120F.

-Sufficient amount of towels and linens available to permit weekly changing, located in the hallway closet.

-Laundry machines (washer/dryer) located in the garage.