Erica Panen will be the administrator to this facility. Administrator certificate number # is 7026719740 and will expire on 11/17/25. The facility has a fire clearance for 6 non-ambulatory residents to accept and retain at any given time, which 1 resident can be bedridden in rear right bedroom #3. The facility will not employ staff who are live-in and will ensure there are care in place for 24/7. There were no residents in care at this time. LPA informed applicant that the physical plant cannot be changed without notifying the department and that the submitted facility sketch needs to be adhere at all times.

The applicant has completed the following deficiencies.

· LPA observed two-emergency exit that are self-closing latches in the courtyard.

· LPA observed the emergency exit is not obstructed and that the new sliding door leaning against the wall is removed.

· LPA observed a designated area for staff file made inaccessible.

· LPA observed complaint poster PUB 475 in the size of 20”X26” is posted in the common area.

· Applicant will continue to be the administrator to the facility and have coverage for childcare and sufficient staffing.

Continued LIC 809-C

· Licensee/Administrator will ensure that an updated plan of operation to include cameras in the dining area and common area. Plan of operation will also include the purpose of the camera, who can view the camera, how long is the recording and that there is no audio.

· Licensee/Administrator will ensure that an updated facility sketch to include the shed in the courtyard and what the shed is used for and where cameras in the facility will be located.

LPA reviewed Component 3 with the applicant. The applicant has passed the pre-licensing component of the application process. LPA will notify the CAB that the pre-licensing has been completed and passed. An exit interview was conducted, and a copy of this report was given to the applicant.