Pre-licensing visit·September 20, 2022

On 09/20/22 at 01:15 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a Pre-Licensing Inspection for a CHOW. LPA was greeted by one Care Staff upon entry and explained the purpose of the visit. Helen Grace Herbert, Licensee and Araceli Emerick, Co-Administrator (Co-ADM) arrived about 5 minutes later. The facility's fire clearance was approved for all six (6) residents of which five (5) may be non-ambulatory and one (1) bedridden. LPA toured facility with Licensee and Co-ADM including, but not limited to five (5) residents' bedrooms, two (2) bathrooms, kitchen, common areas, and backyard. Bedrooms and living rooms were equipped with the proper furniture. The Bathrooms were equipped soap, paper towels and covered garbage cans. Medication and sharps are stored and locked by a combination lock. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. Lighting is sufficient throughout the facility. The room temperature was maintained at 76 degree F and hot water temperature was maintained at 117.8 degree F. First-aid kit was observed complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 08/15/2022. Component III reviewed and completed with Licensee and Co-ADM. During record review, LPA reviewed five (5) residents and ten (10) staff records; the records were current and maintained. LPA observed that facility is 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. Exit interview conducted and a copy of this report provided to Helen Grace Herbert, Licensee and Araceli Emerick, Co-Administrator.