Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez made an unannounced Required - 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Madeleine "Maddie" Sievert, . The purpose of the visit was explained. The following (CARE) tool domains were utilized during the inspection:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located in the main entrance. The facility has an Infection Control Plan.

Operational Requirements: A current Plan of Operation was reviewed. The facility serves residents 60 years and older, and a Hospice Waiver for thirty (30) residents is approved.

Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 06/01/2026. A surety bond is not applicable. Facility does not handle resident's money.

Staffing: There appears to be always sufficient staffing in the facility, with night staff that is trained and able to assist in care and supervision of the residents in the case of an emergency.

Personnel Records/Staff Training: Staff have criminal record clearance, current First-Aid training, medication assistance, and other ongoing training are documented in personnel files. LPA reviewed four (4) staff files with no issues observed. Administrator Madeleine Sievert certificate expires on 06/18/2027

Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, Ombudsman, and let us know poster near the resident mail room (continued on 809C)