Facility Evaluation Report

At 11:55am, 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 12:00pm and the following was observed:

The facility is cleared for five (5) Non-Ambulatory (in rooms #1, #2 and #3) and one (1) Bedridden resident in room #5. 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 purchased on 07/16/2025. Medications and resident/staff files are kept in kitchen cabinet. There is a complete first-aid kit in the cabinet 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. and three (3) bathrooms. 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 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 111.7°F.