Pre-licensing visit·November 12, 2021

Announced Pre-licensing visit made via to this facility on 11/12/2021, LPA Anthony Tuck was met by the Applicant, Angelique Morrow, who was briefly interviewed by LPA. It was learned that this facility will be licensed to serve up to (6) residents, (4) non ambulatory at any given time. (This Applicant was also seeking a program for dementia care and a hospice waiver to accept and retain up to (6) hospice residents at any given time and 2 bedridden.) There were no residents in care during today's Pre-licensing visit. Tour of the facility was conducted with applicant. 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. Kitchen area was toured. Cabinets and drawers were opened and reviewed by LPA Tuck along with the Applicant. Knives and other sharp utensils were observed to be locked in a cabinet to make them inaccessible to the residents at all times. 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 the hallway area, was toured. First aid kit was observed to be present and contained all required components at this time. A tour of the (4) private resident bedrooms was conducted. It was observed that one resident bedroom was equipped with direct exits at this time. Furnishings and furniture intended for use by the residents were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the resident bathrooms was conducted. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Grab bars and nonskid mats were observed to be present and in compliance at this time. Laundry area was toured. All cleaning agents and detergents were observed to be locked and made inaccessible at this time. 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. A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time. Gate latches were reviewed and observed to be functional and allowed access for emergency response. All proper posters were posted on walls. All smoke detectors were operational, and the carbon monoxide detector was operational. There were 0 deficiencies observed during today's Pre-licensing visit. Component III interview was conducted with the Applicant and completed during today's Pre-licensing visit. Exit Interview A copy of this report was provided to the applicant.