Facility Evaluation Report

At 11:30am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an annual inspection. LPA met with the Administrator and explained the reason for the visit.

A tour of the physical plant was initiated at 11:35am and the following was observed:

The facility is cleared for six (6) Non-Ambulatory residents and a hospice waiver/granted for four (4).

Kitchen: The kitchen area is equipped with a refrigerator, microwave oven and sink. LPA observed there to be sufficient stock of perishable and 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 was purchased on 12/03/2024. Medications and resident/staff files are kept in locked cabinet, in the kitchen. There is a complete first-aid kit it with all required supplies and with the first aid manual.

Bedrooms: The facility has a total of six (6) bedrooms, five (5) of which are designated for residents use, one (1) room is designated for live-in staff. The bedrooms are appropriately furnished with sufficient closet space and have sufficient lighting. All exit doors will have an auditory alarm.

Bathrooms: Facility has three (3) bathrooms. Bathrooms have soap, paper towels and all trash cans have a lid. Extra towels and linens were readily available. The hot water temperature measured at 114.1°F. The facility maintains a comfortable temperature of 76°F. LPA observed all common areas are furnished with adequate furniture to accommodate a maximum capacity of six (6) residents. There is a functioning telephone on the premises. Continue on LIC809-C