Facility Evaluation Report

On 07/31/2026 at 12:15 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Kerri Nordstrom, and explained the purpose of the visit. The facility’s fire clearance was approved for capacity four (4), in which two (2) may be non-ambulatory. Administrator certificate # #6073133740 expires 12/03/2026.

LPA toured facility with Ms. Nordstrom including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of four (4) total bedrooms which all bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 68 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathrooms was measured at 110.7 and 107.4 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents.

Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 12/08/2025. Emergency Disaster Plan was last posted on 07/31/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 0701/2026.