Facility Evaluation Report

Licensing Program Analyst (LPA) Amy Goldenberg conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. An initial application to operate a residential care facility for the elderly Facility was submitted to the Central Applications Unit (CAU) in September 2022 for a total capacity of 6 ambulatory residents. Fire Clearance was granted 10/31/2022/. LPA Goldenberg observed the following:

Structure: Facility was a single story house with three (5) bedrooms, Three full bathrooms and one 1/2 bathroom, living room, dining area, and kitchen area, three car garage.

Heating/Cooling System: Central heating and air conditioning systems.

Bedrooms: Each resident bedroom will accommodate ambulatory only clients. All bedrooms were adequately furnished with bed, chair, large closets, appropriate linens, adequate lighting, and an operational smoke alarm.

Bathrooms: Bathrooms have a working toilet, wash basin, and shower with an adequate supply of towels, toilet paper, and toiletries. Water temperature measured by LPA at 107 F.

Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Cleaning supplies and knives/sharp instruments were secured in a locked cabinet and drawer. There was adequate room for food storage. Refrigerator/freezer were in working condition and had sufficient storage for perishable food. There was adequate seating for meals.