Pre-licensing visit·October 24, 2024

Licensing Program Analyst (LPA) K.Kaur conducted a Pre-licensing Inspection on this date. LPA introduced self, stated the purpose of the visit and met with Administrator, William Smith. A tour of the facility was conducted together. This is a change of ownership with 4 residents in care. The facility is a 4 bedroom and 4-bathroom home. Fire clearance granted for 4 ambulatory clients. The facility was observed to be at a comfortable temperature. No passageway obstructions or fire hazards were observed inside or outside. Common areas were properly furnished and well-lit throughout. Medications are locked in closet in the entryway. Living room is equipped with adequate sofas and recliners. Knives and sharps are locked in kitchen cabinet. LPA observed 2-day perishable and 7-day nonperishable food supply. At 10:37 LPA observed Fire Extinguisher was expired with a service date of 10/12/2023. Resident’s bedrooms were observed to be adequately furnished with bed, dresser, chair and adequate lighting. Mattresses and linen were in good condition. Extra linen and towels are available in the hallway closet. At 10:49 AM LPA observed hallway bathroom sink was not draining and black buildup on sink edges. Grab bars installed in shower and by toilet, hand soap and paper towels available for use. LPA observed none of the bathrooms and non-skid mats or strips. Cleaning and Chemical supplies observed locked in the closet next to laundry area across from the washing machines. Carbon monoxide and smoke alarm detectors installed and operational. Trash cans with tight fitting lids are in place. Water temperature measured at 117.9 degrees F. All signs are posted. Adequate outside space for rest and recreational under a covered patio with sufficient seating. Gate is self-closing and self-latching. The following issues will need to be corrected prior to pre-licensing visit and Licensure of facility: 1. Service or replace Fire Extinguisher 2. Liability Insurance expired as of 2021. Provide proof of active coverage or obtain coverage. 3. Post Theft policy, Rights of Resident Councils, Personal Rights of Residents, and nondiscrimination notice Continued to LIC 809-C 4. Compliant Poster needs to be 20 X 26 5. Place Non-Skid mats or Strips in Bathtubs and Showers 6. Repair Hall bathroom sink 7. Assess/clean/repair black buildup on hallway bathroom shower Exit interview conducted. A copy of this report was discussed and provided to Administrator, William Smith, whose signature on this form confirms receipt of this document.