Pre-licensing visit·January 14, 2022

Licensing Program Analyst (LPA), Patrick Shanahan, conducted an announced pre-licensing visit on this day. The Component III was also completed during todays visit. The facility is a six bedroom, single-story home licensed to care for 5 non ambulatory clients and 1 bedridden. LPA was greeted upon arrival and confirmed that COVID screening protocols are in place at the facility. LPA utilized the Residential Care Facility for the Elderly (RCFE) Prelicensing inspection tool to verify compliance with all inspection domains. The facility's common areas and bedrooms/bathrooms were clean, well-furnished and functional. Facility appliances were in working condition, hot water temperature measured between 105 and 120 degrees, and appropriate storage areas were present for cleaning supplies, medications and other hazardous materials. Smoke alarms and carbon monoxide detectors were tested and all were functional No deficiencies observed during this visit. This report will be sent to the Centralized Application Bureau (CAB) You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB analyst. Failure to comply could affect approval of your license