Routine inspection·June 29, 2023

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Shaunda Williams (Administrator) and discussed the purpose of today’s visit. Per Ms. Williams, there has not been any admissions since becoming licensed. Administrator will adhere by the Care Tool requirements prior to accepting the first resident. LPA provided guidance to Ms. Williams on where to retrieve the Care Tool on-line. The facility is to serve 6 ambulatory individuals over the age of 60. This is a 2 story home which consist of (3) bedrooms, (2) baths, living room, kitchen, dining area, office (upstairs) and an attached garage with the laundry unit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for (6) ambulatory. Staffing : Administrator Certificate for Shaunda Williams on file expires on 10/26/23. Personnel Records-Training : First Aid/CPR certification for Shaunda Williams expires on 03/11/24. Resident Rights-Information: Resident rights are posted. Resident Records-Incident Reports: No residents have been admitted since licensure. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Physical Plant & Environment Safety Carbon Monoxide and Smoke Alarms observed. Fire Extinguisher appears to be full. Facility is maintained cleaned and organized. Planned Activities: No residents have been admitted since licensure. Food Service : No residents have been admitted since licensure. Incidental Medical Services : No residents have been admitted since licensure. Exit interview and a copy of this report and appeal rights were provided to Shaunda Williams.