Pre-licensing visit·October 29, 2021

On 10/29/2021 at 10:38 am, Licensing Program Analyst (LPA) Anna Bui conducted an unannounced pre-licensing inspection for a change of ownership. LPA met with Joy Carter, Administrator. Facility has a fire clearance that is approved for 61 nonambulatory and 22 bedridden residents. Facility currently has 59 residents. During today’s visit, LPA toured the facility inside and out. The facility is equipped with smoke and carbon monoxide detectors. Fire extinguishers were observed in the facility, which were all serviced on 06/31/2021. The kitchen, dining, and living room were observed in good repair. Residents bedrooms were observed in good repair, furnished, with clean linens and adequate lighting. Bathrooms were equipped with grab bars, nonskid floors in the shower, and pull chords. The water temperature in 7 resident’s bathrooms measured between 107.4 – 114.3 degrees Fahrenheit. 2 days of perishable and 7 days of non-perishable food were observed in the kitchen. Refrigerator temperature was maintained at 32 degrees Fahrenheit and freezer temperature was maintained at 0 degrees Fahrenheit. The water temperature in the kitchen was measured at 105.4 degrees Fahrenheit. All outdoor and indoor passageways were observed clear and free of obstruction. No bodies of water were observed. Centrally stored medication cabinet were observed locked. First aid kit was available with sterile dressing, bandages, thermometer, scissors, tweezers, and first aid manual. -Continued, see LIC 809-C. LPA reviewed 5 resident files and 5 staff files. Facility staff are fingerprint cleared and associated to the facility. Resident files had Admission Agreement, Appraisal Needs and Services Plans, and Functional Capability Assessment forms. COMP III is waived, as Joy Carter, Administrator, has been an Administrator for 17 years and has already received COMP III orientation. No issues were noted during this Pre-Licensing inspection. LPA observed the facility is ready to be licensed. However, this report will be submitted to the Central Applications Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be needed. This report was reviewed with Joy Carter, Administrator, and a copy was provided.