Pre-licensing visit·August 10, 2021

Licensing Program Analyst (LPA) Anna Bueno arrived at the facility to conduct an announced pre-licensing inspection. LPA met with licensee, Wendell Uson, and explained the nature of the inspection and was granted entry to the facility. LPAs toured the facility inside and out with including, but not limited to the bathrooms, bedrooms, dining areas, kitchen, and laundry. The facility’s fire clearance was approved for 5 non-ambulatory and 1 bedridden. There are 5 bedrooms in total, 4 of which are designated for residents. The facility has a total of 2 bathrooms and 1 are designated only for residents. There is a dementia plan of operation on file. The kitchen was free from hazardous items. Toxins and cleaning supplies were kept in a locked cabinet underneath the sink. LPA observed canned foods. Emergency food was observed. Sharp objects were stored in a locked drawer in the staff room. The laundry area is in the garage and it was locked and inaccessible. The fire extinguisher was new and fully charged. The resident’s bedrooms were clean and furnished according to regulation, which includes proper furniture, dressers, chairs and lighting. Night lights were maintained in hallways and bathrooms. The bathrooms are clean and equipped with grab bars and non-skid surfaces and in the showers. LPA observed additional linens, towels, hygiene items. Medications will be kept in a locked cabinet in the hall. The first aid kit was complete. Carbon monoxide & smoke detector were tested and functioning properly. Auditory devices were operable on all exit doors. No firearms or ammunition were stored at the facility. The outside of the facility is free from obstruction and the side gates remain unlocked. No bodies of water were observed. Resident and staff files will be kept inaccessible in the office. The licensee contained the required training for persons with dementia as well as current FirstAid/CPR certification. The administrator’s certificate expires on 8/8/21 and co-administrator's on 10/3/2021. The facility appears to be ready for licensure. An exit interview was conducted where this report was discussed with and provided to Wendell Uson.