Facility Evaluation Report

On 09/08/2022, Licensing Program Analyst (LPA) arrived unannounced to conduct an annual inspection. LPA was greeted by caregiver, introduced self and stated the purpose of the visit. LPA spoke to Licensee on the phone who was unable to attend the visit in person. Licensee has given permission for caregiver to sign for report based on the LIC 308 on file with the facility. There are four residents present during today's inspection, 3 of which are receiving Hospice services.

LPA conducted a tour of the facility with caregiver. Facility is a 5 bedroom / 2 bathroom home. Facility staff were observed wearing facial coverings. There were no obstructions blocking walkways or fire clearance issues during this inspection. LPA observed a visitor log/temperature log at the entry. Hand sanitizer was available for visitors. LPA observed signs promoting hand-washing, social distancing, and cough/sneeze etiquette throughout the facility.

LPA observed hand sanitizer in resident rooms. Resident bathroom observed to be stocked with paper towels and liquid soap. Hand-washing signs observed in the resident bathroom and kitchen.

LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. LPA checked medications. LPA observed a 30 day supply of PPE and cleaning supplies. No deficiencies issued during this inspection.