South Bay Rsidential Care Home

Type of visit: Prelicensing

Licensing Program Analyst (LPA), Regina Cloyd, conducted an announced visit to the facility for purpose of a pre-licensing evaluation. An application was submitted to CCLD and received on 08/28/2025, for a change of ownership for a Residential Care Facility for the Elderly to serve residents age range 60 and over. The facility is approved for six (6) residents of which five (5) may be non-ambulatory. All bedrooms approved for non-ambulatory residents. Waiver/Granted for hospice care for four (4) residents. Structure: Facility is a four (4) bedroom and two and one-half (2 ½ ) bathrooms, single story house with an attached garage. There is an outdoor back patio with furniture. There are two ramps along the house. Bedrooms: All bedrooms are approved for non-ambulatory residents. Bedroom four (4) is currently set up as a shared room and bedroom two (2) is currently being used as a private room. Bedrooms one (1) and three (3) are private. All bedrooms have the appropriate number of beds, chairs, nightstands/dressers, and lamps in addition to overhead lighting. Continue to LIC809-C. Bathrooms: Both bathrooms have a working toilet, wash basin, and step-in shower. The common bathrooms will accommodate non-ambulatory residents in a wheelchair. There is a private bathroom in bedroom four (4) that is not being used. The half restroom is used by staff. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in the hallway closet. Emergency Phone Numbers, Exit Plan & Menu: The facility has a working landline. There are two fire extinguishers located in the kitchen and dining room area. Food Service: Dishes, cups and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked drawer next to the microwave. Food supply adequately stored in the cabinets and refrigerator and consists of the following: canned goods, fruit, meat, and vegetables. Smoke Detectors & Carbon Monoxide Detector: Electrical & connected. Continue to LIC809-C. Appliances: Stove burners, oven, microwave, washer, and dryer is working. There is one refrigerator in the kitchen and in the garage. Each refrigerator has a measured temperature of at least 40 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. The residence is equipped with central heat. Toxins: Locked/stored in laundry room. Water Temperature: Tested at 119 degrees Fahrenheit. Medications, First-Aid Kit & Book: A first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and first aid manual, which are stored in the laundry room, available for staff use but inaccessible to residents. Reading Material, Games, Equipment & Materials: The facility has board games, cards, books, and puzzles for the residents' use, commensurate with the plan of operation. Pool/Jacuzzi & Pets: None. Continue to LIC809-C. Fire clearance: Fire Clearance with the following special conditions: no special conditions. Pre-licensing Checklist: Completed by licensee and observed by the LPA. Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance. An exit interview was conducted, and a copy of this report has been furnished to the applicant. Accordingly, LPA 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.the state’s words, verbatim · CDSS document, Mar 27, 2026