Pre-licensing visit·November 27, 2024

At approximately 9:00AM, Licensing Program Analyst's (LPA's) Bobby Frank and Chris Arnhold arrived at this facility for the purpose of completing a pre-licensing evaluation. LPA's met with Applicant and toured the facility. The Facility is a 6-bedroom, 4.5-bathroom, single story home. Fire extinguishers were mounted and charged. Smoke/ Carbon Monoxide detectors were tested and in working order. There was a locked area for medications and several for toxins and cleaning supplies. Beds were made with appropriate linens. Resident rooms contained the required furniture in 6 of 6 rooms. Hot water temperature was tested and found to be above regulation between 105 degrees F and 120 degrees F at faucets accessible to residents. This facility has submitted a request for a hospice waiver for 2 and a plan to care for residents with dementia. The plan has been reviewed and all physical plant safeguards have been checked. The applicant's states that they do not plan to advertise at this time. A fire clearance for this facility has been granted for 6 non-ambulatory residents. The following items will need to be corrected before the application will be submitted for review: Backyard sidewalk trip hazards Rear deck repair 7 day hot water temperature log Night light in hallway to common bathroom Lock on staff bathroom door Background clearance Applicant could not provide evidence of Liability insurance at the time of this visit. Applicant will provide evidence of liability insurance prior to accepting residents. Component III orientation was conducted at facility. Applicant conveyed a good knowledge of Title 22 regulations. The pre-licensing evaluation has been completed. Upon receipt and verification of the requested items, LPA will submit the application packet for a final review and approval from the Licensing Program Manager. This report was reviewed with applicant and a copy was provided.