Pre-licensing visit·January 31, 2024

On 1/31/2024, Licensing Program Analyst (LPA), Chinwe Nwogene conducted an announced pre-licensing inspection at the facility. LPA Nwogene met with Applicant, Annie Jane Mikenas and toured the facility. Application: The application is for a Residential Care Facility for the Elderly. The fire clearance has been granted for six (6) non-ambulatory residents. Buildings and Grounds: The home is composed with living room, kitchen and dining room combination, four (4) clients bedrooms, 2 restrooms, a staff room, laundry room, backyard, and a garage. The interior/exterior walkways of the home were observed to be clutter free with no obstructions present. Smoke and Carbon Monoxide detectors were tested and operable. There are no pools or other bodies of water located at the home. According to Annie, there are no weapons stored in the home. Rooms, furniture, beds, mattresses are all in good repair. The bedrooms are furnished and privacy is available. The dining and living room areas/furniture are clutter free and in good condition. Bathrooms were observed to have non-slip mats and grab bar available. The hot water was tested and measured at 117 degrees Fahrenheit which is within regulatory limits. Outdoor areas had sufficient room for activities. A washing machine and dryer are available and in working order. Central heating and air conditioning system installed with a central panel located in hallway to control entire house. Storage and Supplies: Medications will be stored in a locked hallway closet, inaccessible to any unauthorized individuals. Secured areas are available for facility files and resident files. The first aid kit was observed to be available and complete. Cleaning supplies will be stored away in the laundry room, inaccessible to clients. Fire extinguisher was available and fully charged. CONTINUE ON LIC809-C CONTINUED FROM LIC809 Activities: Inside and outside, there are areas for residents to use for their leisure. Backyard is in good condition with a covered patio to provide shade over the outside table and chairs. Activity supplies are present inside the home, including television, magazines, and games. Food Service: Utensils and dishware are sufficient for the requested capacity. The refrigerator and stove are in working order. Sharps will be stored in a locked kitchen cabinet, available only to authorized individuals. Trash cans has tight-fitting lid. Dishwasher will be used to clean and sanitize dishes. All need appliances were present and shown to be in working condition and clean. Fridge and freezer are large enough to accommodate required perishable foods. Forms: The following signs were observed to be posted at the home: Emergency Disaster Plan (LIC 610E), Theft and Loss Policies, Visitors Policy, Personal Rights, rights of resident council, a Facility Sketch (LIC 999), Labor Law Information, and Complaint Information. LPA observed resident bedroom #1 was being used as a staff room and staff room being used as resident bedroom. Annie stated there was a mistake with the bedroom labeling on the facility sketch and a new facility sketch will be submitted. Missing Item ; Updated Facility Sketch Drawers for Resident bedroom #4 LPA Nwogene will inform the Centralized Applications Bureau (CAB) that the home is ready for licensure when proof of the missing items has been received. An exit interview was conducted were this report was discussed with and provided to Annie Jane Mikekna.