Pre-licensing visit·September 7, 2021

Licensing Program Analyst (LPA) Christine Dolores and Licensing Program Manager (LPM) Jackie Jin conducted an unannounced pre-licensing continuation visit from 8/20/2021. LPA and LPM met with Administrator, Diane Atkinson. During today's visit, LPA and LPM observed the following posters: personal rights, if you see something say something, ombudsmen, and resident right to counsel posted. Resident Admission Agreement and Death and Loss policy is available for the public to review upon request. LPA and LPM reviewed 13 resident files and 13 staff files. Facility staff are fingerprint cleared and associated to the facility. Resident files all consist of Admission Agreement, Medical Assessment with TB Information, Consent Forms, Care Plans, Safeguard for Personal Properties and Valuables, and Personal Rights. Staff files all consist of Personal Record, Health Screening with TB Information, and Criminal Record Statement. Component III is being waived because applicant has been a facility administrator since 11/1986. No issues noted during this pre-licensing inspection. LPA and LPM observed the facility is ready to be licensed. However, this report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. This report was reviewed with Diane Atkinson, Administrator and a copy of this report provided.