Facility Evaluation Report

On 04/08/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived announced at the facility to conduct a pre-licensing inspection. LPA met with Applicant, Peter Ssempaka, and explained the purpose of the visit.

During today's inspection, LPA and Applicant conducted a tour of the interior and exterior of the facility to ensure there is no immediate health, safety and personal rights violation. LPA conducted a tour of two (2) shared bedrooms, two (2) private bedrooms, two (2) bathrooms, laundry room, kitchen, garage, backyard, and common areas.

LPA observed the fire extinguisher located near the kitchen to be last serviced on 02/10/2025. The hot water temperature in the bathroom sink was observed to be 115.2 degrees Fahrenheit. LPA observed resident bedrooms to have the proper furniture of comfortable bed, night stand, dresser, lamp and chair. LPA observed the facility to have a proper storage for medications, toxins and sharps which is locked and inaccessible. LPA observed facility to have ample supply of linens. LPA observed the exterior of the facility to be free of obstruction. LPA observed the facility to have the required posters of Community Care Licensing Division and Long Term Care Ombudsman.

LPA and Applicant completed the inspection tool and Comp III. Pre-Licensing completed and no deficiencies was observed.

LPA provided Applicant a copy of LIC 311F. LPA informed Applicant facility is not licensed until Applicant is informed by Centralized Application Bureau Analyst with a copy of facility license.

Exit interview conducted and a copy of the report and 809G was provided.