Pre-licensing visit·July 27, 2021

Licensing Program Analyst (LPA) Albert Johnson arrived and met with Administrator/ Executive Director, who assisted in conducting this inspection. LPA toured Physical Plant, Food Service, Common Areas, Bedrooms, Bathrooms, Kitchen and Medication Storage. Fire extinguisher is current and First Aid fully stocked. Kitchen was clean and good repair. Facility is prepared to provide (7) seven days of non-perishable and (2) two days of perishable food required for emergency shelter in place supplies through food stocks. Bedrooms are one bedroom or two bedroom design. Rooms inspected have appropriate items and are in good repair. Water temperatures in bedrooms were measured at 108.7 and 106.9 degrees Fahrenheit in two different locations. LPA observed medication rooms where centrally stored medications and toxins will be kept, refrigerators, cabinets, and medication carts are locked as well. The medication room doors lock and are inaccessible to residents. Facility will accept total capacity of 77 non-ambulatory elderly residents; in which 4 may be bedridden. Memory care unit was observed in this facility to be clean, safe, and secured. All common areas appear to be free from hazards, clean and in good repair. The Department has received the fire clearance dated 5/24/2021. During this visit, this facility is in substantial compliance and meets the minimum requirements for a RCFE license. Component III completed. Exit interview held with Executive Director and a copy of this report was given at the conclusion of the visit. Application is pending further review.