Facility Evaluation Report

At 12:00pm, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with Staff #1 who granted access to the facility. Administrator arrived shortly after, and LPA explained the reason for the visit.

At 12:05pm LPA conducted a tour of the physical plant and observed the following:

Facility is licensed for capacity of six (6) Non-Ambulatory residents. Hospice approval for six (6) residents is also available.

Facility maintains a temperature of 75°F. LPA observed there to be sufficient stock of one-week perishable foods and two-day non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. All knives were observed to be locked in the kitchen drawer. The fire extinguisher is located in the kitchen area and was last serviced on 09/24/2025. At 12:15pm, LPA observed all medications stored in the kitchen cabinet and kept locked and inaccessible to residents in care. Laundry is located by the kitchen. The washer/dryer appeared to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. There are six (6) bedrooms designated for resident's’ use. Bedrooms are appropriately furnished and have appropriate lighting. Facility has live-in staff and the staff room is located at the den area. Bathrooms have soap and paper towels. Slip-resistant mats are used in all bathtubs and shower floors. All toilets, handwashing and showers are observed to be in good operating condition. All containers storing waste are emptied in a timely manner and observed to be in good repair and free of leaks. Extra towels and linens were readily available. The hot water temperature measured at 117.2°F. Continue on LIC809-C