Pre-licensing visit·May 18, 2021

Licensing Program Analyst (LPA) Liliana Silveira and Licensing Program Manager (LPM) Denise Powell conducted a Prelicensing/Component III Visit to observe the physical plant for compliance with applicant Kelly Welker. The LPA and LPM virtually toured the physical plant and observed resident accommodations including furnishings, linens and personal hygiene items; water temperature was recorded at 120 degrees F; resident bathrooms were equipped with grab bars, bath mats; staff and administrative records are located in a the locked cabinet; food service including dishes, utensils, food storage and a seven day supply of nonperishables; toxic substances are stored locked in the laundry room; medication storage and administration logs are located in a locked cabinet in the kitchen; first aid kit and current first aid manual are located in the office; activities, supplies and sufficient space to conduct are present; fire extinguishers are affixed with a current tag; smoke and carbon monoxide detectors are present and operable; facility posting requirements are present in a common area and the facility administrators certification is current; no pools or other body of water are present on the facility; per the applicant there are no guns, weapons or ammunition located on the property. Discussed with the applicant were Component III, record keeping and physical plant compliance. The applicant shall contact the Centralized Application Unit (CAU) for completion of this pending facility application. An exit interview was conducted with Ms. Welker. A copy of this report and Licensee Appeal Rights (LIC 9058) were emailed to Ms. Welker, who's signature below confirms receipt.