Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 01/14/2024. LPA was met by Administrator Deborah Davis and explained the purpose of the visit. Facility is licensed to residents 60 years old and above. The facility is approved for 1 bedridden and 5 non-ambulatory. The facility may retain 6 hospice residents. LPA requested and obtained a copy of Personnel Report (LIC 500), Resident Roster (LIC 9020) and copy of liability insurance.

LPA OBSERVATIONS: The Facility is a single-story building in a residential area with four (4) resident bedrooms, two (2) shared resident bathrooms, one (1) staff bedroom, one (1) staff bathroom, kitchen, dining room, living room, den/tv room, front yard, backyard and attached car garage.

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

Kitchen: LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7-day supply on non-perishables. Kitchen sink water temperature was measured at 112.3 degrees F.

Dining Room/Living room/Den/TV room: Dining room was observed to be clean and contained table and 5 chairs. Living room area has 2 recliners and additional seating for clients and guests. Den/Tv room was observed to be clean and contained plenty of seating.

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

Resident Rooms 1 - 4: All contained the required furnishings, linens and were observed to be clean. All rooms except rooms #2 and #4 are shared.