Facility Evaluation Report

On 10/24/2024 at 1:35 PM, Licensing Program Analyst (LPA) Eldin Serrano conducted an announced visit to the facility for purpose of Prelicensing evaluation. LPA met with Applicant Jiaqi Li. An initial application to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 06/22/2024 for a total capacity of five (5) of which five (5) can be nonambulatory. Fire clearance was granted on 09/25/2024 for five (5) non-ambulatory residents. LPA Serrano observed the following:

Facility was a one (1) story house with four (4) resident bedrooms, two (2) bathrooms, living room, dining area/kitchen and laundry. There was an attached two (2) car garage in the left side of the house.

Central heating and air conditioning system installed with one (1) central panel located in the hallway to

Each resident bedrooms accommodate any nonambulatory residents. All resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, nightstands, a lamp and an operable smoke/carbon monoxide alarm.

The two (2) resident/staff bathrooms have a working toilet, wash basin, grab bars, non-slip mat and shower with an adequate supply of toilet paper and soap. LPA Serrano tested the water temperatures in the residents' bathrooms. ***CONTINUED ON LIC 809-C***