The applicant is seeking licensure for a Residential Care Facility for the Elderly (RCFE) with a capacity to serve up to six (6) ambulatory residents. The facility has an approved fire clearance for six (6) ambulatory residents. The facility has a dementia care plan on file and will provide care and supervision to residents 24 hours per day. At the time of the inspection, there were no residents in care. A brief interview was conducted with applicant Williams. Applicant Williams will serve as the Administrator of the facility and holds Administrator Certificate #607007470, which expires on 10/14/2026. The facility has completed both an Infection Control Plan and an Emergency Disaster Plan, which have been submitted to Licensing for review and approval.

LPA Lee toured the facility and reviewed the facility sketch. The physical plant was observed to be consistent with the approved fire clearance (STD 850). The facility was clean, organized, and in good repair. The kitchen area was inspected, including cabinets and drawers. Silverware, dishes, and utensils were observed to be sufficient to meet the needs of residents. Knives were stored in a locked cabinet in the garage and were inaccessible to residents. The refrigerator was operational and in good repair. Food supplies were reviewed and found to be sufficient, including at least a two day supply of perishable food and a seven day supply of nonperishable food.

CONTINUED LIC 809-C

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

Resident bedrooms were toured and were not adequately furnished to meet resident needs. Bedroom #1, designated for two residents, contained only one chair and one night stand. LPA Lee informed the applicant that each resident must have access to an individual chair and night stand. Bedroom #2, intended to accommodate two residents, contained only one chair. LPA Lee discussed concerns regarding the room layout and advised the applicant that the room must allow for easy passage between furnishings and adequate space for resident mobility and assistive devices. The applicant was advised to rearrange the room and consider smaller furnishings to ensure compliance. Bedroom #3, also intended to accommodate two residents, contained only one chair and an additional chair was missing. Hot water temperature measured 116.2 degrees Fahrenheit at the resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. Resident bathrooms were equipped with grab bars and non-slip mats. LPA Lee observed that the main resident bathroom did not have a trash can with a fitted lid. Additionally, the bathroom in Bedroom #1 did not contain a trash can. The facility temperature measured 75 degrees Fahrenheit. The hallway did not contain night lights; however, dim lighting was available. LPA Lee advised the applicant to ensure adequate nighttime illumination and not completely turn off hallway lighting, as no hallway night lights were installed.

Medication storage was centrally located in the common area and secured. The first aid kit was inspected and found to be complete. Designated locked storage areas for residents and staff records were available in the common area.

CONTINUED LIC 809-C

The following deficiencies must be corrected prior to licensure:

• Ensure Bedroom #1 contains two chairs and two night stands.

• Ensure Bedroom #2 contains two chairs and is arranged to provide easy passage and accommodate assistive devices.

• Ensure Bedroom #3 contains two chairs.

• Ensure the main resident bathroom contains a trash can with a fitted lid.

• Ensure the bathroom in Bedroom #1 contains a trash can with a fitted lid.

• Ensure the facility posts a PUB 475 Complaint Poster measuring 20 inches by 26 inches.

Per the applicant Williams, during the fire inspection process with the fire inspector she was informed that a fire rated door needed to be installed and the open wall space leading to the resident rooms needed to be enclosed in order to obtain approval for non-ambulatory residents. Applicant Williams stated that the fire rated door has been installed and the open-wall space has been enclosed. During today’s visit LPA Lee did observe a fire rated door installed and no open wall space leading to the resident’s room.

During today's visit, LPA Lee contacted the fire inspector and was advised that a new STD 850 and updated facility sketch must be submitted for review. LPA Lee will complete and submit a new STD 850 to the fire department.

LPA Lee will return to the facility once the noted deficiencies have been corrected. At this time, the applicant has not passed the pre-licensing component of the application process. The applicant shall notify Licensing once all corrections have been completed. An exit interview was conducted with applicant Williams, and a copy of this report was provided to the applicant.