Facility Evaluation Report

Licensing Program Analysts (LPA) Jason Lund arrived unannounced to conduct a one year required inspection visit. LPA Lund was met by Administrator Doris Woodruff and explained the purpose of the visit to staff. Census: 6

LPA Lund and Administrator Doris Woodruff inspected/toured the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 6. There is entry door leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. Chemicals and medications are locked to residents in care. LPA inspected also conducted the care tool. No bodies of water were observed at the facility. Hot water temperature was measured at 105 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. All necessary documents were in place. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. LPA observed the facility to have adequate food supply of 7- days non-perishables and 2- days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. LPA observed, fire extinguishers was purchased on 06/08/2025 and current, smoke and carbon monoxide detectors, central heating and air in the facility. The first aid kit was found in compliance. LPA reviewed three staff files. LPA Lund reviewed three resident facility files and was in compliance.

No deficiencies cited today during today’s visit, exit interview held and report left.