Facility Evaluation Report

Licensing Program Analyst (LPA), Regina Cloyd, conducted an announced visit to the facility for purpose of a pre-licensing evaluation. An application was submitted to Community Care Licensing Division (CCLD) on 12/26/2023 for initial license for a Residential Care Facility for the Elderly to serve ages 60 years and older. The requested capacity is for six (6) non-ambulatory residents of which one (1) may be bedridden. Bedroom #3 is approved for the bedridden resident.

Facility is a four (4) bedroom, two (2) bathrooms, single story house with a detached car garage. The facility is a navy-blue home with a living room, dining room, laundry room (dryer is in the garage), kitchen, and a ramp on one side of the house that wraps around the back. The home has a fireplace in the living room with a metal screen cover, and is inaccessible to residents. Outdoor furniture with an umbrella is in the backyard. Passageways, walkways, driveways, steps and patios are free from obstructions.

There are be no more than two residents per bedroom. Bedroom #3 has two beds, two chairs, two night stands, one closet and two lamps in addition to one mounted lighting. Bedroom #2 has two beds, two chairs, one large dresser, one closet and two lamps in addition to one mounted lighting. Bedrooms #1 and #4 are private and have the required furniture. Continue to LIC809-C.