Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Dolores arrived announced to conduct the pre-licensing visit. LPA met with Kareeb Harbin.

There are no residents on-site. The facility has an approved fire clearance for 28 non-ambulatory residents.

During visit, LPA toured the facility with Kareeb Harbin to include the lobby, resident bedrooms, rest rooms, shower rooms, pharmacy room, office rooms, storage rooms, IT closet, laundry room, kitchen, dining room, common areas, and exterior. All fire exits were free and clear of obstruction. Fire extinguishers were up to date. Facility has carbon monoxide detectors present throughout the facility.

The facility with have a separate entrance for visitors, staff, and residents. The visitor lobby included signs to include but not limited to visitation, grievance, personal rights, and if you see something say something.

Resident bedrooms equipped with beds, clean linens, night stands, lamps, adequate lighting, closets, and lidded trash bins. Room 112 and 113 was approved for 1 bed each per the approved facility sketch. During visit, LPA observed room 112 and 113 was equipped with 2 beds. Room 112 and 113 was equipped with complete furniture to include the list above. Facility was advised to re-submit an updated facility sketch to Centralized Applications Bureau (CAB) for final approval.

The women's and men's bathrooms equipped with toilets, sinks, soap, and paper supplies. Women and men's shower rooms equipped with showers, non-slid floors, and shower chairs. LPA was unable to measure the hot water temperature during visit. LPA scheduled a follow-up visit on 01/22/2024. SEE LIC809-C.