Facility Evaluation Report

At approximately 10:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced for the purpose of completing a pre-licensing evaluation. LPA met with Caregiver Sedra Wilson and toured the facility. Applicant Sylvester Okoro received the Component III orientation on 11/03/2022 for another facility in the area. The facility has 5 bedrooms and 2 bathrooms. Fire extinguishers were mounted and charged. Smoke detectors were tested and in working order. There was a locked area for medications and several for toxins and cleaning supplies. Beds were made with appropriate linens. Resident rooms contained the 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.

At approximately 11:15AM, LPA reviewed 4 of 4 resident files and 2 of 2 staff records. Staff records contained documentation of the required annual training, including current First aid and CPR. Resident records contained the required information.

This facility has submitted a plan to care for residents with dementia. The plan has been reviewed and all physical plant safeguards have been checked. A fire clearance for this facility has been granted.

Evidence of liability insurance received.

LPA will submit the application packet for a final review and approval from the Licensing Program Manager.