Pre-licensing visit·September 17, 2025

On 09/17/25 around 10:00 AM, Licensing Program Analyst (LPA) L Holmes arrived announced to conduct a pre-licensing Inspection. LPA was greeted by Brittany White (ADM) and Lurinza Bean, Licensee arrived about 20 minutes later. LPA explained the purpose of the visit. ADM's Standard Certificate #7026223740 expires 09/20/25 and renewal expires 09/20/27. Licensee and LPA toured the facility including but not limited to the common areas, dining room, bathrooms, kitchen, bedrooms, garage and backyard. The facility consists of four (4) bedrooms and two (2) bathrooms. Outdoor and indoor passageways were free of obstruction. There were not any bodies of water present. A comfortable temperature was maintained at 72 degrees Fahrenheit (F). LPA observed lighting in all areas to be adequate for the comfort and safety of the residents; additional linen, toiletries, and paper goods were readily available. The hot water temperature in the shared bathroom was measured at a minimum required degrees (F) of 105. The shared bathrooms had hand washing soap, paper towels, toilet paper, bathing soap and garbage cans; all areas were safe and sanitary. First aid kit complete. PPE, sanitizer, and paper goods remain sufficient. There will be a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. Smoke/carbon monoxide detectors were in operating condition during visit. Fire extinguisher was observed full and purchased 01/29/25. Emergency Disaster Plan to be added to the emergency binder and safety drills will be performed on a rotational basis. LPA toured where files and medication will be stored and locked. The following forms are to remain updated: -LIC500 Personnel Report & Resident Roster (TBD) -LIC308 Designation of Administrative Responsibility (Reviewed) -An updated copy of Administrator Certificate(s) to be posted (Reviewed) Continued on LIC809C... ...continued from LIC809. LPA observed that the 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 Brittany White, Administrator.