Facility Evaluation Report

On 01/07/2025, at 12:20 PM, Licensing Program Analyst (LPA) Melody Brown conducted an announced visit to the facility for the purpose of a Prelicensing Visit. LPA Brown met with Administrator Christopher Bundalian. An initial application for license to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 10/27/2024 for a total capacity of five (5). Fire clearance was granted on 07/22/2024 for four (4) non-ambulatory residents and one (1) bedridden. LPA Brown observed the following:

Facility was a one (1) level house with four (4) bedrooms for residents, one (1) bedroom for staff, three (3) resident/staff bathrooms, living room, dining area, laundry room and kitchen. There is an attached two (2) car garage.

Central heating and air conditioning system installed with a central panel located in the hallway to control the entire house.

Each resident bedrooms accommodate any non-ambulatory resident, and bedroom #5 was approved for bedridden resident. All resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm.

The three staff/resident bathrooms have a working toilet, wash basin, and tub & shower with non-slip mat with an adequate supply of toilet paper and soap. At 12:50 PM, LPA Brown tested the water temperatures in the resident/staff shared bathrooms. LPA verified water temperature was measured at 105.6 degrees Fahrenheit. ***CONTINUED ON LIC 809C***