Facility Evaluation Report

02/22/2022 10:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility to conduct a Pre-Licensing visit for a re-location application. Prior to initiating the annual inspection, 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. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask, gloves. LPA met with licensee Tasha Tompkins and explained the purpose of the visit.

Comp 3 was waived by licensee as they are currently licensed for 2 other facilities. Licensee plans to close the two existing facilities and relocate all residents into the one new facility.

The fire marshal has approved the fire safety inspection request. The facility is licensed for a total capacity of 8 residents, 3 of which may be non-ambulatory residents.

The inside of the facility was observed to be in good condition and repair. The facility has four (4) bedrooms, four (4) bathrooms, two (2) kitchens, two (2) dining areas, two (2) living rooms, one (1) laundry room, one (1) medication room, and 2 garages. There is currently no furniture located in one living room, and both dinning area. One living room has a couch and love seat. When the licensee closes their two other facilities they will bring the furniture from the other facilities to furnish the new facility.