Pre-licensing visit·July 23, 2024

On 07/23/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility announced to conduct a pre-licensing inspection utilizing the pre-inspection tool. LPA met with Administrator Ginger Nagy and explained the purpose of the visit. LPA and Administrator conducted a tour of the interior and exterior of the facility. Areas toured include but not limited to: three (3) residents shared bedrooms, two (2) bathrooms, kitchen, garage, storage area, and the patio. LPA observed resident bedrooms to have the proper furniture of comfortable bed, night stand, dresser, lamp and chair. LPA observed the facility to have a proper storage for medications, toxins and sharps which is locked and inaccessible. LPA observed facility to have ample supply of personal hygiene, linen, and non-perishable foods. LPA observed the exterior of the facility to be free of obstruction. The temperature inside the facility during the time of inspection was 76 degrees Fahrenheit. The hot water temperature was measured at 115.6 degrees Fahrenheit at the kitchen sink, which is within the required range of 105 to 120 degrees Fahrenheit. LPA observed fire extinguisher located in the hallway to be last serviced on 05/16/24. LPA observed smoke and carbon monoxide detectors to be operable. First aid kit is maintained and ready for use. LPA observed various required postings posted, including the Emergency Disaster Plan and Theft & Loss Policy. LPA observed some games/activities and an operating facility phone. LPA reviewed a sample resident file and found it to contain all the required forms. LPA and Administrator completed the inspection tool and Comp III. Pre-Licensing completed and no deficiencies was observed. LPA provided Administrator a copy of LIC 311F. Administrator will inform LPA once they have their first resident. LPA informed Applicant facility is not licensed until Applicant is informed by Centralized Application Bureau Analyst with a copy of facility license. Exit interview conducted and a copy of the report was left at the facility.