Pre-licensing visit·November 16, 2023

Licensing Program Analyst Chris Arnhold arrived announced to conduct a Pre-licensing Facility Inspection with applicant. Facility has received fire clearance for four non-ambulatory residents, one of which may be bedridden. Applicant has a received a Hospice Waiver for two residents. Facility has included Dementia Care in the Plan of Operation but will not be advertising for dementia. Physical Plant: Facility is a single story, three bedroom and 1 bath home. Required postings were not present. Resident's bathroom is located in common hallway. Night light was not present in hallway. Grab bars and nonskid mat were present. Hot water temperature was 122.1F, which is above regulation. There is a secure area for medication storage. There were extra towels, linens and hygiene products for resident use. Kitchen appliances, utensils, and food preparation areas are in good condition. A seven day supply of non-perishable food was present. Stove knobs can be easily removed when stove is not in use. Toxins and cleansers are secured in the laundry area. One fire extinguisher is located in kitchen and another in the living room. All exits have functional auditory alarms. Smoke detectors are operational. Carbon monoxide detector is present. Windows, doors, walls, ceilings, screens, ramps, paint, and furniture are in good condition. Component III Orientation was conducted at the time of this inspection. Based on the findings during this inspection the following items require completion: -Bedroom 1 needs a chest of drawers and a lamp -Bedroom 3 needs a chest of drawers for each resident and a lamp. -Hot water temperature to be monitored and stay within regulation -Night light near the bathroom -Required postings Applicant will submit self certification that the requested items have been completed. Upon receipt of self certification, LPA will submit this application for review and approval of license to the Licensing Program Manager.