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 1:05pm and was greeted and granted entry by designated Administrator (AD) Donghyun Moon. An application to operate a Residential Care Facility for Elderly (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden clients was received by Community Care Licensing (CCL) on 9/2/2022.

The facility is a one-story home with five resident bedrooms, three full bathrooms, two half bathrooms, living room, kitchen, dining room, garage, staff bedroom and backyard. The backyard is not equipped for outdoor use, because there are no outdoor seating areas. LPA observed a posted See Something, Say Something poster. However, this was not the 20” x 26” PUB 475. There are two outdoor exit gates on either side of the facility. The Northeast exit gate is accessible from all exits except for the Bedroom 3 exit. The Southwest exit gate is only accessible through the Bedroom 3 exit. Doors inside the house are delayed egress and approved via fire clearance.

All resident bedrooms had the required furnishings except for Bedroom 3. LPA observed all other resident beds had linens and blankets. Bedroom 3 does not have a bed. LPA observed all windows were screened. The screen in Bedroom 2 has a hole in it.

Toxins: LPA observed chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to client and will be stored and locked in the garage.

Medications, First-Aid Kit & Book: Medication will be stored in a locked drawer in the Dining room. First aid kit is stored in a cabinet in the Dining Room. The first aid kit has all the required elements.