Facility Evaluation Report

A t 8:30am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with the Administrator and LPA explained the reason for the visit.

At 8:40am LPA conducted a tour of the physical plant and observed the following:

The facility is licensed for capacity of six (6) residents. The fire clearance is approved for one (1) non-ambulatory in room #4 and two (2) non-ambulatory in room #5. The facility also has an approved hospice waivers for two (2). There are four (4) bedrooms designated for clients’ use, of which two (2) bedrooms are private, and two (2) bedrooms are shared. Bedrooms are appropriately furnished and have appropriate lighting. Live-in staff bedroom is located by the kitchen and kept locked at all times. Bathrooms have soap, paper towels and hand washing signs were observed. Extra towels and linens were readily available. The hot water temperature measured at 120.0°F. Facility maintains a temperature of 71°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. There are two (2) fire extinguishers at the facility. One (1) is located by the kitchen and the second (2) fire extinguisher is located in the living room. Both extinguishers were last serviced on 05/29/2025. The laundry is located in the garage. The washer/dryer appears to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. All chemicals, detergents and medications are kept in the laundry room and inaccessible to residents in care. Smoke detectors and carbon monoxide monitors were tested at 9:30am and observed to be functional. At 9:40am, LPA observed appropriate outdoor furniture, with a covered shaded area for residents.