Facility Evaluation Report

At 9:00am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with the Staff #1, who granted access to the facility. Administrator arrived shortly after, and LPA explained the reason for the visit.

At 9:10am LPA conducted a physical plant tour and observed the following:

Facility is licensed for capacity of five (5) Non-Ambulatory of which one (1) may be Bedridden in room #1. Hospice waiver for six (6) residents is also approved.

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 11/06/2024. Facility maintains a temperature of 71°F. Medications, resident/staff files were kept in the kitchen cabinet and observed to be 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. There are four (4) bedrooms designated for residents’ use. Facility has an awake staff. Bedrooms are appropriately furnished and have appropriate lighting. 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 106.3°F. Laundry is located in a hallway, by the garage, and LPA observed all chemicals and detergents are kept locked and inaccessible to residents in care. The washer/dryer appear to be in a good condition. Continue on LIC809-C