Facility Evaluation Report

On 6/9/2023 at 1:00 p.m. 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.

LPA observed all trash cans at the facility to have lids. LPA observed master bathroom shower to be cleaned, extra items in the bedrooms were removed, and bedroom window sills cleaned. AD purchased a lockable container to store medication in the fridge. LPA observed backyard path way to be clear and free from obstruction. LPA observed kitchen and found non-perishable food items to be non-expired. AD provided verification of dryer purchase and will be delivered 6/24/23.

LPA observed the following on 6/9/23 visit:

Physical plant is consistent with the facility sketch/floor plan. Fire extinguisher purchased with receipt attached, current and in good standing. Smoke & carbon monoxide detectors tested & determined to be operational.

Deficiencies were correct and no other deficiencies were found at this time.

Component III was also conducted and completed. Exit interview was conducted. Pre-licensing requirements have been met.

An exit interview was conducted with Administrator. Report LIC809 was signed on-site by Administrator and