Pre-licensing visit·June 28, 2022

Licensing Program Analyst (LPA) JoAnn Rosales conducted a pre-licensing visit to the above noted facility. LPA met with Executive Director Stephanie Funderburg and Regional Director of Operations Michael Fountain. On 6/24/22 LPA received a letter from the Applicant Representative Susan McPherson designating Stephanie Funderburg Executive Director as the Applicant Representative for the Prelicensing visit. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver has been requested. Component III was conducted in conjunction with this pre-licensing visit. The facility is a two-story. A physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for 112 non-ambulatory residents of which 4 are bedridden. The facility has 41 private resident bedrooms, Rooms 101, 107, 109, 115, 117, 119, 121, 123, 127, 129, 131, 135, 136, 137, 138, 139, 142, 143, 145, 147, 149, 151, 153, 155, 157, 159, 161, 162, 163, 164, 202, 204, 205, 210, 216, 221, 223, 225, 229, 235, 238, and 36 shared rooms, Room 102, 103, 105, 111, 125, 133, 140, 141, 201, 203, 206, 207, 208, 209, 211, 212, 214, 215, 217, 218, 219, 220, 222, 224, 226, 227, 228, 230, 231, 232, 233, 234, 236, 237, 239, and 240. Resident model rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All resident rooms have bathrooms. There are no staff rooms - awake night staff only - is required. All rooms were free of odors. All window screens were clean and maintained in good repair. There are 8 public bathrooms in the hallways. There are 3 designated staff bathrooms. The resident bathrooms have showers with non-skid materials. The toilet and shower have grab bars. The hot water Continued on 809C temperature was measured in resident bathrooms as follows: 105*F, 110.2*F, 110.1*F, 113.5 and 110*F which falls within the allowable range of 105*F to 120*F. Resident records will be stored in a locked medication room and the Business Office Directors office and staff records are stored in a filing cabinet which is currently located in the Business Office Directors office. Medications are centrally stored in locked carts and cabinets in the medication rooms. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in the medication room. Kitchen knives are stored in a locked kitchen. The supply of dishes, utensils, pots, pans and drinkware is adequate . The freezer was maintained at 0*F and the refrigerator was maintained at 40*F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet located in the laundry and utility rooms. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment, games and/or activity supplies in the activity room and movie theater. There was sufficient space to accommodate both indoor and outdoor activities. There is a fireplace in the living room. It is screened and there are no tools. Administrator provided LPA with an updated facility sketch which is consistent with the physical plant. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility smoke alarm system is hard wired. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. LPA received documentation of smoke detector test completed on 5/5/22 by Cal Building System. LPA observed fire extinguishers fully charged. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) are stored in the medication room. Extra incontinence supplies are stored in the medication room. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted in the hallways. The emergency telephone numbers are posted in the entryway. Other required postings are posted in the activity Continued on 809C room. LPA observed 19 residential storage units on the Basement Floor. The exterior passageways were clean and clear of any obstructions. There is a patio area in the courtyard of the first floor Assisted Living area and the courtyard of the Memory Care area with tables, chairs and umbrellas where residents can sit. There are no bodies of water on the premises at the present time . Their are 10 garages not accessible from the building for resident use. One of the doors was not locked. LPA reminded Executive Director that once they receive residents, if they store toxic or dangerous items or tools in the garage, it must be kept locked. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.