Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required 1-year Visit on 03/29/2024. LPA was met by Administrator Alaina Hendrick and explained the purpose of the visit. Back up Administrator Elyssa Markie arrived shortly after to assist with the tour. The facility is licensed to serve six (6) non-ambulatory residents over the age of 60 and provides care for elderly residents with dementia and is approved to retain four (4) residents on hospice. Currently the facility has three (3) residents on hospice care.

LPA OBSERVATIONS: The facility is a single-story building located in a residential neighborhood with three (3) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, kitchen, dining room, living room, front yard, backyard, and attached garage.

Front Yard: Was clean and well maintained. No hazards were observed.

Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to five (5) out of five (5) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in kitchen cabinet, to be inaccessible to five (5) out of five (5) residents in care. Kitchen sink water temperature was measured at 109.9 degrees F. Kitchen appliances were observed to be clean and in working order.

Dining Room/Living room/: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting.

Linen Closet: Contained plenty linens, towels, and hygiene products.

Resident Rooms 1 - 3: LPA Ramirez observed all three (3) resident bedrooms to contain required furnishings, lighting, and linens. All bedrooms are shared.

Bathrooms: Water temperature in two (2) resident bathrooms were within 105- 120 degrees F. Bathrooms were observed to be clean and well stocked.