The facility is a one-story home. Beginning at 09:51 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for six (6) bedridden residents. The facility has two (2) private resident bedrooms and two (2) shared resident bedrooms. All resident rooms have direct exits to the outside. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs, and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are no staff rooms awake night staff only is required. All rooms were free of odors. All window screens were clean and maintained in good repair.

There are two (2) bathrooms in the hallway. All resident bathrooms have a shower with non-skid materials. All toilets and showers have grab bars. The hot water temperature was tested in all bathrooms and the kitchen and was found to be within the range of 105*F and 120*F.

Resident and staff records are stored in a locked desk drawer which is currently located in the Administrator’s office. Medications are centrally stored in a locked cabinet in the kitchen. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in a locked hallway cabinet. Continued on LIC 809C.

The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment, games and activity supplies in the living room/dining area. LPA observed cameras located throughout the common areas of the facility. LPA confirmed with applicant that audio is not recorded. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight were made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. There was no fireplace observed at the facility. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit.

The facility’s combination smoke and carbon monoxide alarm system is hard wired. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. There is one (1) fire extinguisher throughout the house. It is fully charged and does not exceed the expiration date.

Continued on LIC 809C.

The exterior passageways were clean and clear of any obstructions. There is a covered patio area on the side of the house with tables and chairs where residents can sit. The entire property is fenced. The gate to the driveway is moved manually. There is a door gate for persons to enter the front yard. There are two (2) locked storage sheds located in the back yard. There are not any bodies of water on the premises at the present time.

Component III (COMP III) orientation was completed with the applicant at the time of this inspection. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.