Facility Evaluation Report

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual required 1 – year inspection visit of the facility. LPA met with Resident Care Director (RCD)/ Designee Jodie Niezgoda, Administrator, Audreanna Verling was not available. There is a total of 33 residents, 14 of which have dementia diagnosis. There are 3 residents currently on Hospice.

At approximately 9:45 AM, LPA toured the building and grounds with RCD which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use and daily schedule of five activities posted on activity door. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerator and freezer were clean, and food was stored properly per Title 22 Regulations. Toxins are stored in a locked housekeeping closet in the hallway. Water temperature measured between106.1 degrees F & 119.8 degrees F within regulations of 105 and 120 degrees F at 9 out of 9 randomly sampled faucets accessible to residents in care. Fire extinguishers inspected were last charged on 7/18/2023. Smoke detectors and Carbon Monoxide detectors were tested and found to be in working order. Facility has fire sprinklers throughout that were last inspected 4/2023. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure.

A review of five staff & five resident records as well as two resident’s medications was conducted. At approximately 12:30PM, LPA reviewed 5 staff records and found 5 of 5 files for staff requiring current CPR training was observed, and completed training records as required including course details and hours of completion provided, although 3 of 5 new staff did not have current First Aid (see LIC9102-TV) class scheduled. All facility staff present and a sample of others who require caregiver background checks have received criminal record clearances or exemptions. LPA interviewed 5 staff during this inspection.