Pre-licensing visit·April 30, 2021

On 04/30/2021 Licensing Program Analyst (LPA) Leslie Ibo made a scheduled tele visit to this facility for the purpose of completing a Pre-licensing inspection. LPA met with Applicant Brian Friedel & Brenda Wiliamson. LPA observed no residents were present during today’s visit. At 1:00 PM , LPA toured the entire premises indoors and outdoors. The facility has 4 bedrooms , 3 1/2 bathrooms, one story house per facility sketch. 3 bedrooms are designated for residents & 1 bedroom for facility staff. LPA observed 2 fire extinguishers which was in the kitchen and one fire extinguisher adjacent to bedroom #2 & #3. Smoke detectors and carbon monoxide detectors were observed operational. The facility received a fire clearance dated 03/25/2021 with an approval for a total capacity of 6 residents, approved for 6 non-ambulatory residents. LPA observed a locked cabinet for centrally stored medications at the laundry room. Kitchen and dining room floors are clean and sanitary, food preparation area has an operating ventilation fan, there are no pesticides, poisons, or other toxins stored in any food storage or preparation area, cleaning supplies are kept separate from food supply. The facility has a supply of 7 days of non-perishable and have at least 2 days perishable food. There are enough amounts of tableware, tables, dishes, and utensils. There are enough amounts of equipment for the storage & preparation of food. All equipment and dishes are clean and in good repair and there is at least 1 dining room convenient to the kitchen. Hot water temperature was tested at 111.11 degrees Fahrenheit. Refrigerator temperature was observed at 37 degrees Fahrenheit and freezer was observed at 0 degrees Fahrenheit. Continue LIC809C... 3 Bedrooms were observed furnished with a bed, bedding, and night stand, a chair, and a closet space. There were no bodies of water present at the facility. Outside pathways to security exit gate were unobstructed. There is confidential storage for personnel and resident records. There are games, activity supplies, and reading materials available. There is an outdoor area, that appears comfortable and furnished for residents to entertain friends and relatives. LPA observed the first aid kit was complete with manual. During today's visit, LPA reviewed LIC 610E Emergency disaster plan/Fire and Earthquake drill requirements with applicant. LPAs observed the facility had the necessary posters in place (Complaint poster, LTCO poster, Rights to Council, etc). COVID-19 posters were also displayed in the main entrance, common areas and the bathrooms. Comp III was discussed with Applicant. LPA recommends approval for the license is pending , until the following item is completed: · Active telephone line that will be available for residents Exit interview conducted with Applicant Brian Friedel & Brenda Williamson and a copy of report will be emailed.