Evergreen Care Manor

Type of visit: Prelicensing

On 07/24/26, at 1:00pm, Licensing Program Analyst (LPA) Perry Scott conducted an announced visit to Evergreen Care Manor, Residential Facility For The Elderly. LPA was greeted by applicant, Arlene Feliciano. LPA explained the purpose of today’s Pre-licensing inspection visit. An application was submitted to Community Care Licensing Division (CCLD) on 06/25/25 for a change of ownership and change of name for a Residential Care Facility for the Elderly aged 60 and over. The applicant requested a capacity of six (6) non-ambulatory individuals; of which one (1) may be bedridden. The facility is a single-story structure located in a residential neighborhood. The facility consists of 6 bedrooms, 4 bathrooms, and staff room. The home includes a living room, family room, kitchen, and laundry area. The living area included table, sofa, and a television. The kitchen has a refrigerator, stove, and microwave. The rear exterior is fenced throughout with several patios that includes tables and chairs. The passageways, walkways, and steps are free from obstructions. At 1:20pm, LPA and staff toured the facility. There are no bodies of water or firearm/ammunition on the premises. All resident rooms were checked. Beds and bedding were in good condition, adequate lighting provided, and adequate storage for resident personal belongings was observed. Each room had the required furniture: at least one (1) full-size/Queen bed, one (1) chair, one (1) nightstand, and table lamps. All bedrooms are equipped with ceiling lighting, and a dresser. Report Continued On LIC809-C All rooms have closets with ample storage space. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly. The shower was free of mold/mildew, there was adequate lighting, and sufficient toiletries were accessible to residents. The water temperature measured 113.4F degrees in the bathroom. A comfortable temperature is maintained in the facility. LPA observed the facility to be clean, sanitary, and appropriately furnished at the time of visit. Storage areas for cleaning agents, toxins, and sharps were inaccessible to residents. The kitchen was inspected and there is enough perishable and non-perishable food available for the residents. All food items were stored properly. The water temperature measured 117.3F degrees in the kitchen. Stove burners, oven, and washer and dryer are working. Medications were centrally stored and properly locked. A first aid kit and manual were stored in a locked cabinet, which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, and gauze that were inaccessible to residents. The fire extinguishers were charged, and the smoke and carbon monoxide detectors were operable throughout the facility. The facility’s administrator’s certificate (7005359740) was valid from 04/04/2026 through 04/03/2028. LPA observed the facility had a place for staff and resident records that were secured. A Fire Clearance inspection was conducted on 06/04/2026 and approved for a capacity of six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility’s liability insurance was valid from 12/29/2025 through 12/29/2026. LPA conducted a review of (5) resident records, (5) staff records, and reviewed the facility emergency disaster plan. Staff and resident records were complete with required documents and training. LPA did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on the front and back exits. All door exits had an alarm mechanism. The facility has board games, books, magazines, and other recreational materials for the residents. Report Continued On LIC809-C Component III: LPA and the applicant completed the Component III PowerPoint presentation, which gives an overview of what to expect while running a Residential Care Facility for the Elderly. During the pre-licensing inspection no items were observed which do not comply with applicable laws and regulations; no items require a follow up inspection for verification of correction. Pre-Licensing is complete, and this facility has no deficiencies. The department will submit a copy of this Facility Evaluation Report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application. An exit interview was conducted, and a hard copy of this Facility Evaluation Report was given to the applicant, Arlene Feliciano.the state’s words, verbatim · CDSS document, Jul 24, 2026