Facility Evaluation Report

On February 16, 2022, at 2pm, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived announced to conduct a Pre-Licensing Inspection. LPA met with Administrator Kimi Cost ar. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) An N- 95 mask was worn.

The facility is a single floor facility and has 7 bedrooms and 3 bathrooms. It has a capacity of 6. The facilities Administrator’s Certificate, Emergency Disaster Plan, Resident’s Rights and Facility Sketch was available for viewing. The room temperature was 71 degrees.

LPA inspected the interior and the exterior of the facility including the common living spaces, resident's bedrooms and bathrooms, kitchen and dining room. In the kitchen area, Knives and sharp objects are locked and made inaccessible to the residents. The first aid kit was complete with scissors, thermometer, tweezers and a guide. The hot water temperatures were taken and measured degrees F. There’s appropriate lighting throughout the facility. Dining room, and areas designated for residents, were toured. Furniture and furnishings were observed to be sufficient and in good repair. Resident's bedrooms and bathrooms were toured. All Bedrooms had all the required items of furniture. Window screens appeared to be in good repair. Bathrooms were clean and sanitary. The sinks, toilets, showers and tub operate properly. Fire alarms, smoke alarms, and carbon monoxide detectors operate properly. Fire extinguishers are maintained and ready for emergency use.

LPA observed a medication room with locked cabinets and an area were files will be held. There are no medications or staff and client files available for review because the facility has no residents at this time.