Pre-licensing visit·June 7, 2022

Licensing Program Analyst (LPA) JoAnn Rosales conducted a pre-licensing visit to the above noted facility. The LPA met with applicant Christine Rowe, assistant Administrator Toni Dart and assistant Administrator Cecilia Daniels. This is a new facility. A dementia program was included in the plan of operation . A Hospice Waiver for 6 has been approved. Component III was conducted in conjunction with this pre-licensing visit. The facility is one story. At 10:00 am a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for 6 non-ambulatory residents of which 1 may be bedridden. The facility has 6 private resident bedrooms, Room #6 is an approved bedridden room and has a direct exit to the outside. The facility does not have fire sprinklers. All resident rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. The beds are furnished with comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket, bedspread and rubber sheeting. 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. 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 2 bathrooms in the hallway. 1 bathroom is designated as a visitor and staff bathroom. The master bedroom has a bathroom. The resident bathrooms have showers with non-skid mats. The toilets and showers have grab bars. The facility has 1 water heater and the hot water tested in the resident bathroom at 119.1 degrees F. which falls within the allowable range of 105 degrees F to 120 degrees F. Resident and staff records will be stored in locked filing cabinets in the locked garage. Medications will be centrally stored in a locked cabinet in the kitchen. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in the locked garage. Continued on 809C Kitchen knives are stored in a lock box in a drawer in the kitchen. Stove burners are rendered inaccessible to the residents by removing them when not in use. The supply of dishes, utensils, pots, pans and drinkware is adequate . The freezer was maintained at 0 degress F. and the refrigerator was maintained at 37 degrees 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 garage. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment, games and activity supplies in the living room. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. There is not a fireplace in the living room. Alarms on all exterior doors were functional at time of visit. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. T he 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. There are 2 fully charged fire extinguishers throughout the house. The laundry area is located in the garage. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in the garage. Extra incontinence supplies are stored in the garage There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted in the entryway hallway. The emergency telephone numbers are posted in entryway hallway. Other required postings are posted entryway hallway. The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the back of the house with tables and chairs where residents can sit. The entire property is fenced. The back and sides of the house are separated from the front yard by gates at the east and west side passageways . Continued on 809C There is no driveway gate. There is a door w/gate with a self-latching mechanism for persons to enter the front yard. There is a locked storage shed in the back yard. There are no bodies of water on the premises at the present time . The garage is not accessible from the house; the doors were locked. Exit interview conducted. A copy of the report was emailed to the applicant. 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.