Facility Evaluation Report

This report was transferred over from the LIC809 dated 01/16/2025 for facility #197610652 where it was erroneously placed.

Licensing Program Analysts (LPAs) Nadia Shahbazian and Abeye Duguma conducted a Pre-Licensing

Inspection with the Margaret Kayiira/administrator at 10:00am. An application to operate an Adult Residential Facility (ARF) was received by Community Care Licensing (CCL) on 05/24/2024. A fire clearance was approved on 06/17/2024 for four (4) ambulatory residents, for a total capacity of four. The smoke alarms and carbon monoxide detectors are dual and inter-connected. The facility has a fire extinguisher purchased on 06/30/2024. Fire extinguisher is located in the kitchen.

With the assistance of the administrator, a tour of the physical plant was initiated at 10:30am and the following was observed:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, stove/oven, microwave oven and dishwasher. There was an adequate supply of non-perishable food items observed. Perishable food items not required at this time as there are no residents. Administrator was advised facility needs to carry perishable food items once they admit residents for care. Knives were observed locked in a kitchen drawer. Cleaning supplies observed locked in the garage cabinet.

BEDROOMS: There are four (4) private bedrooms, three bedrooms will be used for residents and one bedroom for staff. Bedroom two (2) will be utilized as the staff bedroom. Each bedroom was furnished with beds, chairs, dresser drawer and closets, bedding and linen. The bedrooms have sufficient lighting. Bedroom one (1) is near the entry door and had two closets.