Pre-licensing visit·January 6, 2022

Licensing Program Analyst (LPA) Dominic Tobola arrived to this facility for the purpose of completing a pre-licensing evaluation. LPA was greeted by Licensee/Administrator Applicant Janai Booker and conducted a tour of the facility. The facility is a 4 bedroom, 2 bathroom, single story house. LPA toured the entire premise which was found to be clean and orderly. Fire extinguisher last inspected along with fire clearance on 8/3/2021. Smoke detectors and interconnected with carbon monoxide detectors which were all tested and found to be in working order. Medications, facility files and emergency supplies are stored in a secured cabinet located in the dinning area. Toxins and cleaning supplies are secured in locked cabinets in the garage. Sharps and knives are secured in a locked cabinet in the kitchen. LPA observed at least a minimum of a 2 day supply of perishable and 7 day supply of non-perishable food necessary for 5 clients. There is a closet located in the hallway that holds extra linens. Beds were made with appropriate linens. Furniture is appeared safe and adequate. Hot water temperature was measured at 114.8 degrees F which is within regulation between 105 degrees F and 120 degrees F. A fire clearance for this facility has been granted for 2 ambulatory residents, 2 non-ambulatory residents and 1 bedridden resident. An emergency exit along the right side of the facility are unobstructed and equipped with self closing latches. Component III orientation was conducted with the Licensee Applicant. The pre-licensing evaluation has been completed. License will be granted upon completion of a final review and approval from the Licensing Program Manager. This report was reviewed with applicant and a copy was provided to the Licensee via email. Signatures on file.