Facility Evaluation Report

Licensing Program Analyst (LPA) Kesha Lewis and Licensing Program Manager (LPM) LIza King made an announced visit to the facility to conduct a pre-licensing visit on 12/22/2022 LPA Lewis and LPM King identified Them self and discussed the purpose of the visit with licensees and administrator.

The facility has a fire clearance for a capacity of 4 (2 ambulatory , 2 non-ambulatory and 2 bedridden residents). LPA observed there are no residents at this time.

LPA Lewis and LPM King inspected the interior and exterior of the facility. At this time, the pre-licensing visit is complete. The applicant has passed the pre-licensing component of the application process today.

An exit interview was conducted and a copy of this report was left at the facility.