Facility Evaluation Report

Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted a Pre-Licensing Inspection with the facility Administrator Therese V Gaiete. This is a Change of Ownership Application from facility #197602380 to #197610623 to operate an Adult Residential Facility Level 2. A Change in Ownership (CHOW) Application to operate an Adult Residential Facility (ARF) was received by Community Care Licensing (CCL) on April 26, 2024. A fire clearance was approved on August 26, 2024 for four (4) ambulatory clients for a total capacity of four. The smoke alarms and carbon monoxide detector are hard wired and inter-connected. The facility has one fire extinguishers that was purchased on November 20, 2023 and is located in living room area.

A tour of the physical plant was initiated at approximately 11:30am and the following was observed:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, gas stove, microwave oven and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of four (4). Knives and other sharps were observed locked in a hallway drawer.

BEDROOMS: The facility has 5 bedrooms, four (4) bedrooms are designated for clients' private use and one (1) bedroom for staff use. The applicant furnished all clients' bedrooms with beds, night stand, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space.

BATHROOMS: The facility has three (3) bathrooms, two (2) are designated for clients' use, and one (1) is for staff use only. Bathrooms were observed to have the proper fixtures, grab bars, non-skid mats, trash cans with closed lids. The hot water delivered in the bathrooms measured at 11:45am to be at 111.7 degrees.