Pre-licensing visit·April 8, 2021

Licensing Program Analyst (LPA) Kruz Long conducted an announced Pre-licensing inspection. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today's inspection was conducted via Microsoft Team (Video Conference) with Nichole Greene (Administrator). An application was received for initial License #198603428, Residential Care Facility for the Elderly. AGE RANGE 60 AND OVER. APPROVED FOR 49 AMBULATORY AND 111 NON-AMBULATORY, INCLUDING THOSE IN MEMORY CARE UNIT WITH DELAYED EGRESS. HOSPICE WAIVER APPROVED FOR 15 RESIDENTS. The facility is a 3 story building consisting the following: First floor contains common areas, medication rooms, multipurpose room, activity room, lobby, bistro, parlor, library, dining room, kitchen, offices, memory care and assisted living apartments. Second floor contains a laundry room, parlor, activity office, storage room, office and assisted living apartments. Third floor contains a laundry room, billiards room, storage room, assisted living apartment. During today's inspection, LPA observed the following: · Facility is clean, sanitary and in good repair. · Bedrooms are large enough to accommodate furniture. · Each apartment has its own bathroom which have working toilets, wash basins, showers, grab bars and non-skid mat/floors. · Each resident bedroom has its alert button. · Hygiene supplies are available for resident use. · Emergency Phone Numbers, Exit Plan & Menu are posted & readily available for review. Continue to LIC809C... · Fire Extinguishers are fully charged. · Smoke Detectors and Carbon monoxide detectors are operational. · Water Temperature measured within Title 22 guidelines in all floors. · Kitchen contain the necessary food supplies. · Dishes, cups and flat ware are in good repair. · First aid kits are located in the medication rooms, front office and kitchen. · There are no Pool/Jacuzzi on the premises. · Medications are centrally stored in the medication room. · Chemicals agents are safely secured and inaccessible to residents. · Cameras are located in the common areas. · There are outdoor shaded areas. · Passageways, stairways, walkways, driveway and steps are free of debris and obstructions. Fire Safety Clearance was granted on 04/01/21. Component III : Waved: Licensee is currently operating under License #292700563 of the same category. During the pre-licensing inspection, LPA did not observe items which do not comply with applicable laws and regulations. Tele-inspection was completed and an exit interview was conducted. Copy of this report was emailed to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.