Facility Evaluation Report

Licensing Program Analysts (LPA's) Jenifer Tirre and Edward Kim made an announced pre-licensing visit. LPA's identified themselves and discussed the purpose of the visit with Administrator Ali Naghlbli. An initial application to operate a Residential Facility Care for the Elderly was submitted to CCL on 8/1/2023. There are 6 residents in care during today's visit. LPA's observed facility is following infection control policies.

LPA's Tirre and Kim along with Administrator Naghlbli toured the facility at 9:00 AM and observed the following:

Structure: Facility is a single story residential home with seven bedrooms (six resident rooms, one caregiver room). Facility has attached garage. Living Room/ Dining Room : Adequate seating is available in the main living room. Bedrooms Residents: All rooms are equipped with appropriate lighting, chair, night stand, dresser and ample closet space. Bathrooms: All resident bathrooms have a working toilet/ wash basin. Facility has Seven restrooms. Six of seven restrooms have grab bars and non-skid surface in the shower. Emergency Phone Numbers and Exit Plan: Posted in facility. Food Service: Facility has ample perishable and non perishable food supplies. All equipment is tested for temperature and are within acceptable ranges. LPA observed a posted menu with multiple choices for residents. Smoke Detectors: Carbon monoxide detectors and Smoke detectors were tested operational. Fire extinguishers are fully charged, mounted and inspected October 10, 2023. Toxins : located in garage in an unsecured location. Water Temperature: Tested and recorded between 105.2 and 109.5 degrees F in tested bathrooms.

Emergency Supplies: LPA’s observed ample emergency food and water stored on site in facility storage.

LPA'S observed the emergency disaster plan and facility has submitted Infection control plan. Medications, First-Aid Kit & Book: LPA’s observed first aid kits and contained required elements. Medications are stored in locked medication cabinet.