Pre-licensing visit·January 4, 2022

Licensing Program Analyst (LPA) Steve Chang conducted a pre licensing inspection visit, and met with administrator (ADM) Justin Ladwig. Upon arrival, ADM took LPA body temperature and checked LPA into the guest book. Screening station with thermometer, masks, hand sanitizer was observed at the main entrance. COVID posters were observed at the main entrance and in facility. ADM's wife Irish Ladwig (IL) was observed in facility. LPA toured the facility inside out with ADM. LPA inspected family room, kitchen, dinning area, 2 reading rooms, and laundry room. Medication closet, knives closet, and cleaning product closet were observed locked. There are 6 single rooms for residents, and one staff live-in room in facility. 3 bathrooms were inspected. ADM stated the facility will put non-skid mats in bathrooms. Not all paper towels were with holders, ADM stated the facility will fix this issue in two days. Room temperature was observed at 70 degree F, and hot water temperature was observed at 112 degree F. The facility is equipped with smoke and carbon monoxide detectors. The facility equipped with fire alarm. ADM tested the smoke and carbon monoxide detectors, and they were working fine. ADM tested the fire alarm, and it was working fine. The fire extinguishers were observed on service on 11/05/2021. LPA inspected the backyard, there was no obstruction to block the walkway. LPA discussed LIC808 mitigation plan with ADM. ADM stated all staff are fully vaccinated and done with booster shots. Component III orientation was conducted with ADM. No deficiency or issue noted during inspection. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was emailed to ADM.