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 the 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. Facility also has a hospice waiver for one (1) resident. 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 6/24/2024. Medications and resident/staff files are kept in a kitchen cabinet and observed to be locked and inaccessible to residents in care. The first-aid kit has been inspected which has at least the following: tweezers, scissors, antiseptic, bandages, gauze, thermometer; including a current First Aid manual.

Facility is a single-story home consisting of seven (7) bedrooms and three (3) full bathrooms. There are six (6) private bedrooms designated for residents use. Only master bedroom has a private bathroom. Live-in staff bedroom is located by the kitchen area. LPA observed that all bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting.

At 12:20pm LPA observed all bathrooms are clean and in good repair. All three (3) bathrooms have a working Continue on LIC809-C