Facility Evaluation Report

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection. LPA arrived at the facility at 8:40 am and was greeted and granted entry by designated Administrator (AD) Josephine Teehankee. An application to operate a Residential Care Facility for Elderly (RCFE) for (6) capacity, (0) ambulatory, (1) non-ambulatory, and (5) bedridden clients was received by Community Care Licensing (CCL) on 9/9/2022.

The facility is a two-story home with six resident bedrooms, four resident bathrooms, one staff bedroom, one staff bathroom, family room, kitchen, dining room, an attached two car garage and backyard. The second story of the home houses the staff bedroom and bathroom. LPA observed the door leading to the second story to be locked. Residents are not permitted to go upstairs. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the family room. There is an open office space for staff to use in the family room. LPA observed the office space to be free from hazards to clients. There is a back yard with two exit gates. The facility has two shaded seating areas. LPA did not observe any obstacles or hazards in the backyard.

All resident bedrooms had the necessary furnishings. LPAs observed all resident beds had linens and blankets. LPA observed all windows were screened. Each bedroom has a door leading outside. Each of these doors has an alarm that sounds upon the opening of the door. This sound will notify staff in case they need to check on the open door.

The facility utilizes a signal system for each resident. The monitor for the system is located in the dining room. Each resident is associated with a different number that will appear on the signal system’s monitor.