Facility Evaluation Report

Licensing Program Analysts (LPAs) Kimberly Lyman and Kevin Saborit-Guasch made an announced visit to conduct a pre-licensing inspection. LPAs identified themselves and discussed the purpose of the visit with Administrator Aurelia Olais. An initial application to operate a Residential Care Facility for the Elderly was received by CCL on 04/09/2021 for a capacity of fifty five non-ambulatory residents. Administrator Aurelia Olais has an administrator certificate expiring on 11/22/2022. Licensee Dillon Hassan arrived during the visit.

LPAs Lyman and Saborit-Guasch along with Administrator Olais toured the facility at 9:30 AM and observed the following:

Structure: Facility is a one story, two building facility with a tan exterior. The exit gate is closed and equipped with delayed egress. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: Rooms are a mix of single and double occupancy. All rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Bathrooms: All resident bathrooms have a working toilet/ wash basin as well as grab bars and non-skid surface in the shower. Facility has designated shower rooms for residents. Linens & Hygiene Supplies: Linen supply is in ample supply for residents in care. Emergency Phone Numbers and Exit Plan: Available for review in the entrance area of the facility. Food Service: Facility has ample 2 day perishables as well as 7 day non-perishables in the pantry. Facility provided proof of daily temps on refrigerators and freezers. Smoke Detectors: Smoke detectors are centrally wired and tested by an outside agency. Carbon Monoxide detectors tested operational. Fire extinguishers are mounted and charged. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins / Sharps : Secured in various locations.. Water Temperature: Tested and recorded between 105 and 120 degrees F. in facility bathrooms. Emergency Supplies: LPAs observed ample emergency food and water as well as thirty day supply of PPE, soap and sanitizer. CONTINUED ON LIC 809C DATED 12/17/2021