Facility Evaluation Report

At 11:30am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced 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 Fire Clearance is approved for a maximum capacity of six (6) residents, of which five (5) can be Non-Ambulatory and one (1) Bedridden residents. Hospice waiver for six (6) residents is also approved.

Kitchen: The kitchen area is equipped with a refrigerator, microwave oven and sink. 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 was last serviced on 07/10/2025.

Bedrooms: The facility has five (5) bedrooms designated for residents’ use. The bedrooms are appropriately furnished with sufficient closet space and have sufficient lighting. All exit doors will have an auditory alarm. The facility has awake staff

Bathrooms: Facility has two (2) bathrooms. Bathrooms have soap, paper towels and hand washing signs were observed. 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 105.4°F

Common Areas: Medications and resident/staff files are kept in a metal, file cabinet, located by the kitchen and kept locked and inaccessible to residents in care. There is a complete first-aid kit in the cabinet with all required supplies and with the first aid manual. Continue on LIC809-C