Pre-licensing visit·September 9, 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. LPA toured the facility inside out with ADM. LPA inspected living room, kitchen, dinning area, 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. 2 bathrooms were inspected. Non-skid mats and handle bars were observed in bathrooms. Room temperature was observed at 74 degree F, and hot water temperature was observed at 110 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 3/31/2022. LPA inspected the backyard, there was no obstruction to block the walkway. LPA discussed Infection Control Plan with ADM. ADM stated ADM will send it to LPA. 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.