Facility Evaluation Report

On 3/22/2023 at 10:30 am Licensing Program Analysts (LPAs) V Gorban and B Miranda arrived at facility to complete an announced Pre-Licensing visit. LPAs met with Administrator (AD) Johnson Wanjau.

Physical plant toured. Regulations reviewed. Facility is clean & in good repair. Interior & exterior passageways free of obstructions. Items that could pose a danger, such as disinfectants, cleaning solutions, etc., are inaccessible. Sufficient lighting & furnishings in common area. Facility has a common area for residents interact with each other. Locked centralized storage area for medications. First aid kit complete. Hot water tested & measured in kitchen and read at 118 degrees F. Physical plant is consistent with the facility sketch/floor plan. Fire extinguisher purchased with receipt attached, current and in good standing. Smoke & carbon monoxide detectors tested & determined to be operational.

Component III was also conducted and completed. Exit interview was conducted. Pre-licensing requirements

were met. An exit interview was conducted with Administrator. Report signed on-site by Administrator and