Facility Evaluation Report

On 5/14/2026, Licensing Program Analyst (LPA) J. Leffall arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by Staff (S1) D. Forbes. Administrator (A1) Camalah Kopacz arrived shortly after LPA’s arrival. 4 residents were present during visit. 2 residents reside at this location and the other 2 reside at Dignity Gardens Home #1. They are temporarily residing in this location because of renovations taking place at Dignity Gardens #1. A1 states residents will reside here until or before 6/1/26.

LPA toured facility with A1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Samples of resident’s medications were observed locked in kitchen cabinet. Clients’ MARS was reviewed with samples of resident’s medications. Fire extinguisher reviewed with a service date of: 5/22/25. Fire drill completed on 3/24/26. Clients' bedrooms were toured and reviewed. Cleaning chemicals were observed stored and locked in closet. Residents bedrooms observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a range of 111.9 to 113.1 degrees in 2 bathrooms. 2 insects found in the bathroom while water temperature was being tested.

Outside of facility toured. Outside observed free of debris. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Freezer temperature observed at 0 degrees F and refrigerator temperature maintained at 37 degrees F. Smoke detectors and carbon monoxide were tested and observed to be operational. All clients’ files and staff’s files reviewed to have all the required documents. Medications and MAR’s reviewed. 1 resident’s medications found accessible in unlocked drawer in the kitchen.