Facility is a two-story building with four (4) bedrooms, four (4) bathrooms, laundry room, living room, office, dining area, kitchen and attached garage. LPA observed clients’ bedrooms with the required bedding and furniture, such as, clean mattresses/linen, night stands, dressers, chairs, lighting, and emergency lighting. Client bathrooms had clean appliances that were operating in safe and sanitary condition and the showers contained non-slip surface. Facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Water temperature in the kitchen and bathrooms measured within regulation at 114.8 degrees F.

Client and staff files will be locked in the office cabinet. Client medication will be centrally stored and locked in the office cabinet. There are no pools or body of water in the premises. There is a covered patio area with seating for all the clients. All passageways were free from obstruction. LPA observed a fire extinguisher in the facility with the last service date of 4/7/24. The smoke detectors and carbon monoxide alarms were operational. Applicant stated that there are no known firearms and ammunition on the facility. LPA observed the required postings of the emergency disaster plan, resident personal rights, complaint procedures, employee rights, visitation rights, facility sketch, and the Long-Term Care Ombudsman poster. Facility contains emergency supplies and first aid kits with the required items. The facility has working telephone for client use.

(Continued on LIC 809 C)

LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. LPA determined the facility meets the operational requirements for license. The Pre-licensing is complete, and this facility has no deficiencies. An exit interview was conducted, and this report was discussed and provided to applicant Kimberly Hall.