Pre-licensing visit·May 20, 2021

Licensing Program Analyst (LPA) Jim August conducted an announced visit to the facility for purpose of a pre-licensing evaluation and Component III. LPA August was greeted and granted entry by Administrator Lorna Smith. Administrator Smith has an administrator certificate which expires on June 30, 2021. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on October 15, 2020 for a capacity of 6 non-ambulatory residents. LPA August along with Administrator Smith toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of 5 resident bedrooms, 2 resident bathrooms, living room, dining room, family room and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 118.0 and 118.4 degrees in resident bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps in a locked chest under the kitchen burners. LPA toured the locked garage and observed additional food, water and emergency supplies. Smoke detectors and carbon monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers were fully charged. Outside grounds were toured and no bodies of water were observed. LPA noted the outdoor walkways had chairs and household items that were planned to be discarded soon. There are no security bars or weapons on the premises. Exit gate is unlocked and will require a self latching mechanism be added. LPA observed the first aid kit contained all required items including tweezers, thermometer, and scissors. LPA confirmed the facility has an active certificate of insurance for liability. Continued on LIC809C... Medications are stored in a locked cabinet. The facility will offer several activities such as special occasion/holiday activities, games, bingo, enjoy outdoor time, music therapy, church services, gardening and exercises. The facility is ready to be licensed. As noted above, a Component III was conducted during this visit as well. An exit interview was conducted and a copy of this report was provided to applicant.