An application was submitted to CCLD on April 30, 2026. In the initial license application for a Residential Facility for the Elderly, ages 60 and above. The applicant requested a capacity of (6) non-ambulatory, of which (1) may be bedridden in bedroom #4. Bedroom #1 approved for (2) non-ambulatory. Bedrooms #2, # 3, #4 approved for (1) non-ambulatory. The home is approved for (6) hospice residents.

Structure:

The facility consists of (4) resident bedrooms (2) resident bathrooms and (1) staff room. The facility is situated in a residential neighborhood. The facility has its kitchen, living room, dining room and laundry room in the garage. The passageways, walkways, and steps are free from obstructions.

Resident's Bedroom:

The facility had four (4) rooms with (6) twin-size beds, one (1) chair, one (1) nightstand, one (1) dresser, and one (1) table lamp. All rooms had ample storage in the closets. The facility allows residents to either furnish their rooms with their own furniture or utilize furniture provided by licensee.

Evaluation Report Continues

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

Each unit has a bathroom. All bathrooms have a working toilet, washbasin, and shower with grab bars.

Linens & Hygiene Supplies:

Beds have the required linen/supplies which include pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. The facility also provides linen and furnishings for residents who may require their own, as well as hygiene supplies.

Emergency Phone Numbers, Exit Plan & Menu:

Emergency phone numbers, exit plan, and menu are posted and readily available for review throughout the facility. There are fire extinguishers on in the kitchen and the dining room and fully charged. All rooms have a telephone line available and internet services. All exit doors have sensors.

Food Service:

Dishes, cups, and flatware are stored in the kitchen, inspected, and in good condition. Knives, cutlery, and other sharp kitchen utensils are stored in drawers in the kitchen. Food supply is adequately stored in the kitchen and consists of perishables and non-perishables food.

Smoke Detectors:

Smoke and carbon monoxide detectors throughout the interior. Hardwired smoke detectors throughout the common areas and in each resident’s room. Carbon monoxide in each resident’s room. The facility is equipped with central heat throughout the common areas. Resident rooms #1 and #4 have wall air conditioner.

Water Temperature:

The water temperature ranged from 106.9 degrees F. throughout the kitchen and bathrooms.

Toxins:

All toxins are stored in storage closets underneath the kitchen cabinet and the garage cabinets.

Evaluation Report Continues

The facility had gas stove burners, microwave, washer, and dryer. The kitchen also had small appliances which included a toaster, a rice cooker, coffee maker, and hot water kettle. There are two refrigerators in the kitchen and the other in the garage. The refrigerator has a measured temperature of at least 45 degrees Fahrenheit for appropriate food storage. A freezer is at (45) zero degrees Fahrenheit.

Medications, First-Aid Kit & Book:

Several first aid kits are available and stored at the hallway credenza. They have at least the following: a thermometer, tweezers, scissors, antiseptic, bandages, gauze, and a current first-aid manual. The residents’ medications will be stored in the locked living room cabinet.

Resident & Staff Files:

Records for staff and residents are stored in living room in locked credenza.

Reading Material, Games, Equipment & Materials:

The facility has board games, books, magazines, and other recreational materials for resident use, stored in the hallway credenza.

Pool/Jacuzzi & Pets:

No jacuzzi or pool in the area. The Admission Agreement or Plan of Operation did not include accepting pets.

Fire clearance:

A Fire Clearance inspection conducted on May 21, 2026, with approval for a capacity for (6) non-ambulatory and (1) for bedridden.

Security:

Currently the facility does not have interior surveillance cameras in common areas.

Evaluation Report Continues

(LPA) Dabuet conducted the Pre-Licensing inspection along with the information provided about how to operate the facility within substantial compliance with Component III.

PowerPoint.

An exit interview was conducted, and a copy of this report has been furnished to the applicant, Arlene Garde (LPA) Dabuet will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.

END OF REPORT