This prelicensing inspection is for a change of ownership with residents in care. The facility is a single story building with 6 bedrooms, 3 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 nonambulatory residents, of which 1 may be bedridden in Bedroom #3. The facility serves residents with dementia. Approved hospice waivers for 6.

Upon entry, LPA observed a maintained front yard. Signs were posted which directed visitors to the rear of the facility towards the main entrance. There, signs were posted for the facility’s masking requirement, as well as a sign which read “No smoking – Oxygen in Use”. Additional postings inside included confidential complaint contacts, Ombudsman contacts, emergency disaster plan, resident rights, rights of resident councils, theft and loss policy, non-discrimination notice, COVID precautions, and administrator certificate.

LPA was screened for infectious disease upon entry. The screening station contained a standing digital thermometer, surgical masks, gloves, hand sanitizer, and a visitor log. Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. The living room contained socially distant furniture, an appropriately grated fireplace, board games, and a television. 5 linen closets in the hallway contained an adequate supply of fresh linens and towels.

At 1:27 p.m. LPA tested the carbon monoxide detector near the kitchen to be operable. The facility had a fire alarm at the front door and fire sprinklers in each bedrooms. At 1:30 p.m. LPA tested the smoke alarm in the hallway to be operable. When tested, 2 out of 2 smoke alarms functioned simultaneously. 8 out of 8 auditory alarms were on and functioning. At 1:32 p.m. LPA measured the room temperature to be 72 degrees Fahrenheit. A fully charged fire extinguisher was mounted near the kitchen. It was last inspected on 07/11/2022. Administrator showed a complete first aid kit which was locked a cabinet near the dining room.

LPA observed an adequate supply of perishable and non-perishable food in the kitchen. At 1:36 p.m. LPA measured the refrigerator and freezer temperatures to be 37 and 0 degrees Fahrenheit, respectively. The stove hood was clean, and all surfaces were sanitary. A facility menu was posted. Appliances were functional. Sharps were locked under the counter top, and cleaning solutions locked were locked under the sink. Medications were locked near the dining room, and refrigerated medications were locked in a separate refrigerator. Employee and resident files were also locked near the dining room. Employees retained the keys on their persons.

The facility had 3 bathrooms. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At 1:40 p.m. LPA measured the water temperature in the shared bathroom to be 117.1 degrees Fahrenheit.

An operable washer and dryer were located in the locked garage. Detergent was stored in a separate, locked cabinet. Paper supplies, emergency water, and assistive devices were also stored in the garage. A covered patio area contained furniture in good repair. The back yard also had a gardened area.

All emergency exit paths were free from obstructions. Both exit gates were unlocked with inward facing latches. Facility sketches with exit paths were posted and clearly labelled.

At approximately 2:30 p.m. LPA and Administrator reviewed Component III.

Pre-Licensing is complete and this facility has no deficiencies. Exit interview conducted. Copy of report provided.