Pre-licensing visit·April 21, 2022

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a pre-licensing visit. LPA met with Sara Post, Administrator. There is currently residents living at the facility. The facility has three floors to consist of assisted living and one floor memory care. The facility has an approved fire clearance for 140 non-ambulatory and 21 bedridden residents. LPA toured the facility inside including the apartments, bathrooms, kitchen, and common areas. Resident apartments were equipped with proper furniture and lighting. Resident apartment temperature was maintained between 74 to 77 degrees Fahrenheit. Residents are responsible in providing personal bedding and linens upon admission. Facility does not provide bedding and linens. Bathrooms are equipped with grab bars, nonskid floors, hygiene supplies, and toiletry. Facility is equipped with cups, plates, utensils, and cooking supplies. Hot water temperature was measured between 111.3 to 113.3 degrees Fahrenheit. The facility has designated medication rooms with locked medication cabinets. LPA reviewed centrally stored medication records with residents medications. LPA observed first aid kit. LPA observed locked medications, sharp objects, and cleaning supplies. Continue on LIC-809C LPA observed 2 days worth of perishables and 7 days worth of nonperishable. Refrigerator temperature was maintained at 31 degrees Fahrenheit. Freezer temperature was maintained at 1 degree Fahrenheit. Facility is equipped with smoke detectors, carbon monoxide detector, and fire extinguisher. Hallway and passageways were observed free of obstruction. The following posters observed: personal rights, if you see something say something, ombudsmen, and resident right to counsel posted. LPA reviewed 6 resident files and 5 staff files. Facility staff are fingerprint cleared. Resident files consist of Physician's Report, TB information, Emergency Information, Centrally Stored Medication Records, and Personal Rights. Staff files all consist of Personal Record, Health Screening with TB Information, and Criminal Record Statement. Component III is being waived. The Department is recommending licensure pending the plan of correction for the deficiency issued during today's pre-licensing visit. See LIC809 for 04/21/2022 under facility #435202621. LPA 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 Sara Post, Administrator and a copy of this report was provided.