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25 | ***Amended to correct number of facility bedrooms
At approximately 1:00PM, Licensing Program Analyst Angela Elliott conducted a virtual Pre-licensing Facility Inspection with Applicant and Administrator via Zoom due to COVID - 19 precautions.
The facility is a 5 bedroom, 2 bathroom single story facility. The facility was clean and in good repair, with walkways unobstructed. Fire extinguisher was charged. Smoke detectors were tested and in good working order. There was a locked area for medications and hygiene supplies in the middle hallway cabinet. Knives were secured in a locked cabinet in the kitchen. Beds were made with appropriate linens. Resident rooms contained required furniture in 5 out of 5 rooms. Hot water temperature was tested and found to be within regulation between 105 degrees F and 120 degrees F at faucets accessible to residents. Exit doors had working alert devices installed. 2 out of 5 residents did not have Resident Appraisal information in resident files. Applicant agrees to submit resident appraisal information for 2 residents to LPA prior to licensure.
Component III orientation was conducted with Licensee and Administrator.
The pre-licensing evaluation has been completed. Due to COVID-19 precautions, LPA sent a copy of this report to Applicant for signature. Upon receipt of signed LIC809, LPA will submit the application packet for a final review and approval from the Licensing Program Manager.
This report was reviewed with applicant and a copy was provided.
Original signature on file.
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