Pre-licensing visit·January 17, 2023

On 1/17/23, Licensing Program Analyst (LPA) Kevin Mknelly conducted a pre-licensing inspection with Licensee. Prior to initiating the annual inspection, LPA completed the Department's required COVID-19 protocols. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA were screened by facility staff upon entering the facility. Administrator is present at the facility to conduct an annual inspection. LPA toured Physical Plant, Food Service, Common Areas, Bedrooms, Bathrooms, Kitchen and Medication Storage. Fire extinguisher is current and First Aid is fully stocked. Kitchen was clean and good repair. Licensee has knowledge of (7) seven (2) two day supply of non-perishable and perishable, and required emergency shelter in place supplies. Rooms inspected have appropriate items and are in good repair. LPA observed centrally stored medications and toxins are to be kept locked and inaccessible to residents. Staff and resident files are to be set up to contain required documents (see next paragraph). Covid 19 guidelines and signage are adhered to. LPA issued an advisory for R1's medication records to be updated- Physician's orders for all medications and a PRN authorization form to be completed/ updated prior to licensure. Facility will accept total capacity of six elderly residents. LPA observed this facility appears to be clean, safe, and secured. All common areas appear to be free from hazards, clean and in good repair. As of this date, the Department has received the fire clearance. During this visit, this facility is in substantial compliance and meets the minimum requirements for a RCFE license. Prior to license issue, licensee will correct R1's medication records. Component III was waived. Application is pending further review. Report reviewed and copied to licensee