Facility Evaluation Report

Licensing Program Analyst (LPA) Sakinah Madyun conducted an unannounced Required Annual Visit. LPA met with Licensee Deborah Davis, Administrator Daniel Davis, and explained the purpose of the visit. The Residential Care Facility for the Elderly is licensed to serve six (6) Non-Ambulatory residents ages 60 and above. Facility has an approved Hospice Waiver to retain/accept six (6) residents of which two (2) may be Bedridden. Currently, there are three (3) residents in placement, one (1) Hospice, zero (0) Bedridden (0) Exceptions, and one (1) receiving Home Health Care. LPA observed (3) residents at the time of this visit. LPA Madyun requested copies of Personnel Report (LIC 500), and Resident Roster (LIC 9020) were provided.

Physical Plant/Environment Safety: A tour of the single-story facility began at approximately 10:35 am that included rooms: one (1) private staff bedroom with an exiting door, one (1) staff/visitors bathroom, one (1) staff lounge (located in garaged area), five (5) bedrooms with an exiting door, one (1) resident bathroom, a living room, a dining area, a family room, and a kitchen. All resident bedrooms have the required furniture for privacy, comfort, and safety. LPA observed the carbon monoxide detectors, fire sprinklers, and inter-connected smoke detectors throughout the hallways and rooms. LPA observed required auditory devices on exits of each room. Three (3) Fire extinguishers were fully charged and located in the kitchen, garage, and directly outside the staff office and last inspected on 6/7/25. First-aid kit was fully stocked with a first-aid manual locked securely in the staff office. LPA did observe the Emergency Disaster Plan last reviewed and updated May 2025.

Front Yard: Was clean and well maintained without any hazards.