Pre-licensing visit·August 21, 2024

On 08/20/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannonced pre-licensing inspection visit. LPA met with administrator Minnie Weber and explained the purpose of today's visit. This is a three level facility with a memory care are named "Evergreen" which currently there are 17 residents currently residing in. There are 58 residents in assisted living. Seven residents are currently on hospice. LPA toured facility and grounds. This is a three level facility. LPA observed resident rooms at random. All rooms observed contained the required furniture items outlined within regulations including flash lights and non-skid mats in resident showers. Personal protective equipment (PPE) is in place in an exterior storage area outside of the facility. Perishable and non-perishable food supplies are in place. Food preparation and service items are present in the main kitchen and in other food serving areas such as the dining rooms for assisted living and memory care. Hot water temperature is tested at 110F. Carbon monoxide and smoke detectors are hard wired and operable. The facility is fully equipped with fire sprinklers through out all areas in the facility. LPA observed multiple fire extinguishers through out the facility, including the kitchen, with inspection/service date of 01/30/2024. Fire pull stations are located at fire exits. Emergency exit routes are observed to be clear of obstructions inside and outside. Medications are secured in the primary medication room on the second floor. Medications are observed to be locked. Toxins, chemicals, and other cleaning supplies are inaccessible to resident in care. Based on observations made LPA did not observed any such items accessible to residents during this inspection visit today. LPA observed two laundry rooms, one on the ground floor and one on the third floor, and both are operational clean and functioning. The third floor of the facility is where secured memory care is located. There is an outdoor patio on this level that is in good condition and a secured perimeter with furnishings. There are an emergency set of keys in place accessible to staff and emergency personnel if needed. The administrator Minnie Weber is the current facility administrator. LPA requested the required items to have her name transferred as administrator. Component III RCFE orientation is provided to the administrator. This pre-licensing is complete and this facility has no deficiencies. *** AMENDED SECOND PAGE DUE TO ERROR. THIS PAGE SHOULD NOT HAVE BEEN GENERATED AND IS INTENTIONALLY LEFT BLANK ***