Facility Evaluation Report

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff and explained the reason for the visit. LPA was informed that Administrator Cherie Wood could not attend the annual due to traveling. LPA contacted the Licensee to attend the annual inspection. LPA was informed that the facility doesn't have an administrator designee. At approximately 10:00 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are interconnected and battery-operated. There is a carbon monoxide detector that functions properly installed in the living room.

The fire extinguisher is charged and located in the kitchen. Kitchen: The kitchen appliances and fixtures were functional. LPA observed clutter on the breakfast table and a bottle of insect killer on the floor. LPA found an insufficient amount of perishable and non-perishable food at the facility; sharp objects were stored in an unlocked drawer in the kitchen. LPA observed a bottle of a cleaning solution under the kitchen sink unlocked. LPA observed flies in the kitchen and the kitchen fridge was unclean with spoiled fruits, vegetables, and leftover food. The laundry area is located through the kitchen. LPA observed that all laundry detergents were unlocked. Bedrooms: The facility has five (5) bedrooms. Four (4) bedrooms are designated for residents' use and one (1) bedroom is designated for staff. All four bedrooms, in use by residents, were properly furnished with appropriate bedding and linens with sufficient lighting.

Bathrooms: There is one (1) bathroom designated for residents' use. The bathroom was properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 110.3 degrees Fahrenheit. No cleaning supplies or hazardous items were present in the bathroom during the inspection.

Common Areas: These included the living room and dining area. The common areas were properly furnished. Properly labeled medications were locked in one of the living area cabinets. Surrounding Grounds: LPA observed that outdoor area is cluttered. LPA observed old mattresses, wheelchairs, hospital beds, dining table, and electric saw. LPA also observed that both emergency exits were locked. There was furniture appropriate for outdoor, however, LPA was informed that residents don't go outside. (Continue 9099C)