Pre-licensing visit·August 24, 2021

Licensing Program Analyst (LPA) Elizabeth Hamilton conducted a Pre-Licensing visit due to a change of ownership. LPA identified herself to the Applicant's General Manager, Lori Hanson, and discussed the purpose of the visit. The facility will serve 100 non-ambulatory elderly residents, fifteen (15) of whom may be bedridden. A hospice waiver has been approved for fifteen (15) residents. The fire clearance was approved on June 23, 2021. LPA conducted a tour of the facility, both inside and outside. Smoke and carbon monoxide alarms were present throughout the facility. Per Mrs. Hanson, there are no firearms stored on the premises and no bodies of water. The facility was observed to be clean and in good repair. Bathrooms intended for resident use were clean and in good repair. Resident rooms were observed with the appropriate furniture, bedding and appropriate lighting. Hot water temperature was measured in the facility at 112.5, 113.5, 115.9, 115.3 and 113.5 degrees F. The refrigerator and freezer were observed to be clean and operational. Cleaning solutions were also properly secured. There is sufficient activities space throughout the facility. There is a locked medication room. Personnel and resident records are store in a locked office on the premises. Emergency chair in the stairwell was observed. Ms. Hanson’s Administrator Certificate is valid until June 9, 2022. The Component III portion of the application process was completed with Mrs. Hanson. Upon receipt, this application will be sent to the Centralized Applications Bureau (CAB) for final review and approval. The Applicant will then be notified of management approval by phone and the new license will be mailed to the Applicant. An exit interview was conducted with Mrs. Hanson and a copy of this report along with Applicant Rights (LIC9058 01/16) was provided to her via email. An electronic receipt of confirmation was requested to be sent upon receipt of the documents.