Pre-licensing visit·August 9, 2024

Licensing Program Analyst (LPA), Martha Arroyo conducted a pre-licensing visit to this property. LPA met with Applicant Representative Sara Jackson as this is a change of ownership application from Sally’s Residential Care Home #565800345 to Sally Residential Care Home 2 #565850409. The applicant has obtained fire clearance for a total capacity of six (6) residents, all of which may be bedridden in bedrooms #1 - #4. The facility has a dementia program in place. LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The smoke alarms and carbon monoxide detectors were tested and function properly. LPAs observed one (1) fire extinguisher to be new and fully charged on 08/04/2024. There is two (2) double occupancy bedrooms and two (2) single occupancy bedrooms for resident use and one (1) staff room. Each bedroom is equipped with clean mattresses, pillows, and bedding. Bedrooms have sufficient lighting. There is a cabinet in the hallway with a sufficient supply of linens, including blankets, bath towels and wash cloths. There is a locked closet with the resident’s personal hygiene items. The facility has two (2) bathrooms for resident use. Resident bathrooms contained appropriate non-skid mats and grab bars. Bathrooms have sufficient paper products. Hot water temperature was measured in both bathrooms, and they measured between 105- and 120-degrees Fahrenheit. LPA observed trash cans with tight fitting lids at the time of the visit. LPA toured the kitchen area at 10:12 a.m. The facility has at least seven (7) day supply of non-perishable food and two (2) days perishable food. Appliances and all equipment appear to be clean and in good repair. Kitchen knives and sharps were observed in a locked drawer next to the range. The kitchen has a sufficient supply of plates, cups, cookware, and utensils. Report Continued on LIC 809... Report Continued from LIC 809... The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. Fireplace was adequately covered. Enough seating for six (6) residents at the same time in the dining room table. A working telephone is present. There are activity supplies in the living room. Night-lights were present in the bathrooms and in the common areas. All doors have functioning auditory alarms when opened. Cameras were observed in common areas. Medications are stored and locked in a file cabinet adjacent to the dining room. Facility records and First aid kit was by the medications. First aid kit was observed to have bandages, thermometer, scissors, tweezers and a current first aid manual. Facility has an adequate 30-day supply of Personal Protection Equipment (PPE). The garage is attached to the house and inaccessible to residents in care. The washer and dryer was observed inside the garage. Detergents, disinfectants, and cleaning supplies are stored locked and inaccessible. There will be no firearms/ammunition stored on the property. There is a sufficient supply of emergency food and water. The facility has required postings, including emergency exit plan, Licensing Complaint Poster, Resident Personal Rights, Theft and Loss Policy, and Resident Council Rights. The exterior passageways were clean and clear of any obstructions. There is one (1) self-latching gate for emergency use. There are no bodies of water on the premises at the time of the visit . LPA observed the backyard, which has a covered outdoor area with a table and chairs for resident use. Comp III conducted with Applicant Representative. Physical plant is NOT accurate with the submitted facility sketch / floor plan. There are five (5) rooms total. Four (4) bedrooms for resident use and one (1) staff room. Sketch submitted only shows three (3) bedrooms. Report Continued on LIC 809C... Report Continued from LIC 809C... The following needs to be completed prior to licensure: · Submit a new facility sketch / floor plan and obtain fire clearance for additional rooms. 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. Exit interview conducted. The report was reviewed, and a copy was provided.