Facility Evaluation Report

Licensing Program Analyst (LPA) Yatfai Eric Ng conducted an announced pre-licensing inspection. LPA met with the Prospective Administrator (PA). Fire clearance granted this facility a capacity of total 6 residents. This facility was a 1 story building. This facility was licensed in another area, planned to move to this location once approved. There was no resident in the current location.

LPA toured the facility inside and outside. At the entrance, there were COVID-19 precaution signs. The facility was well lit and in good repair, LPA did not see any damaged window screens, cracked floor, or broken furniture, etc. The fire place had a glass screen. Facility's living room, dining room, and 3 residents' rooms for 6 residents had functioning light fixtures. Hot water temperature was measured at 116.1 degrees F in the 2 restrooms. Detergents were stored in the locked cabinet in the garage. There was a functioning refrigerator in the kitchen. The centrally stored medication had a lock present, ready for storage. First-aid kit was examined and contained all required components per regulation. LPA tested the carbon monoxide/smoke detectors and alarms, they appeared to be functioning. Fire extinguishers were fully charged, last serviced in 6/8/2021. There was no obstruction in all passageways inside the facility, and there was no obstruction in any of the emergency exits. There was no open body of water outside of the facility. Component III orientation was given to PA.

This application pending the approval of the PA's administrator certificate renewal or hiring a certified administrator. The physical plant is approved pending the completion of Centralized Application Bureau (CAB) review of the facility application.

This report was reviewed with PA. A copy of this report was provided.