Facility Evaluation Report

Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA met with Administrator Sandra Graves. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Administrator.

A tour of the facility was conducted with the Administrator. The residence was set at 75 F temperature and free of passageway obstructions inside and outside.

LPA Doucette observed 4 bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean. Hot water temperature was measured 110.3 F.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Knives were stored in a locked closet. Medications were stored in a locked closet. Cleaning supplies were in a locked cabinet in laundry room and locked in a cabinet in garage. First Aid Kit contained the required supplies. Smoke detectors and carbon monoxide detectors were checked and operating. Facility has a pull station fire alarm. Fire extinguishers were charged and had service dates of 1/17/23. Fire drill was last completed on 5/7/23.

LPA observed a self latching gate on the outside of the residence. There was outdoor seating for the residents.

Resident, medication and staff records were reviewed and found to be complete. Current first aid and CPR were on file for staff.

An exit interview was conducted with the Administrator. A copy of this report was discussed and left with the Administrator, Sandra Graves, whose signature on this form confirm receipt of these documents.