Pre-licensing visit·August 24, 2021

Licensing Program Analyst (LPA) Michael Bilger conducted an announced pre-licensing visit to this facility on 08/24/2021 at 9:44am and was met by the Applicant, Penya Hill. A Brief interview was conducted with the Applicant. It was learned that this facility will be licensed to serve up to 6 non-ambulatory clients. There were no clients present during today's pre-licensing visit. Tour of the facility was conducted. Dining area, living area, and all other areas intended for resident use were toured and observed to be furnished and maintained in compliance at this time. COVID Precautions in place. Isolation rooms designated. LPA observed no obstruction of emergency exits. Fire extinguisher in place in kitchen and fully charged. Complaint poster observed. Kitchen area was toured. Cabinets and drawers were opened and reviewed by this LPA along with the Applicant. Food supply for 2-day perishable and 7-day nonperishable quantities were reviewed to make sure that this facility was in compliance at this time. Medication cabinet located in hallway was observed. First aid kit was observed to be present and contained all required components at this time. A tour of the resident bedrooms was conducted. Furnishings and furniture intended for use by the clients were observed to be sufficient and able to meet the needs of the clients at this time. A tour of the resident bathrooms was conducted. Hot water temperatures were taken and measured within the allowed range of 105-120 degrees. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels and linens able to meet the needs of the residents at this time. LPA received COVID mitigation plan during visit. {Cont. on 809C} A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed. This facility has been found to require the following in place before considered for licensure: 1. Ramp to be installed at outside exit from main sliding door and resident room #3 sliding door 2. Facility flooring to be free of dirt and clutter 4. Facility sketches to be posted 5. Ombudsman poster to be posted 6. COVID-19 signage to be posted Exit Interview conducted with Penya Hill. A copy of this report was left with the Applicant