Pre-licensing visit·February 4, 2022

On 2/4/2022 at 10:25 a.m., Licensing Program Analyst (LPA) Catherine Lin arrived unannounced to conduct the 2nd Pre-Licensing inspection. LPA met with Caregiver Apollo Mckarson and explained the purpose of the visit. Both facility Licensee and Administrator were unavailable during inspection. Licensee Mynette Boykin authorized caregiver Apollo to give tour to LPA and sign on report. The facility currently has 6 residents including 4 non-ambulatory and 2 ambulatory. LPA toured facility including but not limited to 6 bedrooms, 2 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 72 degrees F and hot water temperature was maintained at 113 degrees F. First-aid kit was observed to be complete. Smoke detector and Carbon monoxide were operational. Fire extinguisher was last serviced in Feb 2021. Prior to licensure, the following shall be corrected and faxed to CCL by 2/18/2022. Centrally stored medication was unlocked, in-services training is required. Centrally stored knives was unlocked, in-services training is required. Staff personnel records are required to be completed Used needles were disposed in a opened plastic bag, a secured container for disposed needles is required. Continue on LIC809-C Issues were noted during inspection. LPA observed that facility is not ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Component III was not conducted at this time due to absence of Licensee and Administrator. Exit interview conducted with Caregiver, and a copy of this report provided.