Facility Evaluation Report

On 6/9/2023 Licensing Program Analyst (LPA) B. Miranda arrived at facility to complete an announced Pre-Licensing visit. LPA met with Administrator (AD) Jeffrey Tinius. LPA toured the facility inside and out. During the tour AD verified all four bedrooms will be occupied by residents. 2 rooms have 2 beds and 2 rooms have single beds. AD verified there will not be live in staff at the facility.

During the tour LPA observed all 4 bedrooms to have adequate furniture, storage, and lighting. Fire extinguisher is current and in good standing. Smoke detectors and carbon monoxide reader are in working conditions. Water temperature was checked in kitchen and read at 114.4 degrees Fahrenheit.

AD explained washer is in the garage and is not accessible to residents for now. AD stated in the future washer and dryer will be accessible once garage is cleaned & cleared. Garage is not listed as a fire exit, only the front and back door are listed as fire clearance exits.

2. Shower in master bedroom needs to be cleaned

3. All extra items need to be removed from rooms.

5. Container is needed to keep medication in the fridge.

7. All expired food needs to be discarded.

Pre-licensing is incomplete with deficiencies to be resolved by 6/23/23. A follow up pre licensing LIC 809 will

be generated upon resolution of the deficiencies. Another facility visit will be conducted on 6/23/23 at 1:00 pm.

Exit interview completed and a copy of this report was provided to AD Jeffrey Tinius.