Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted an annual inspection visit. LPA met with Cholly Sason and discussed the purpose of today’s visit. Tiffany Vander Poorten (Administrator) arrived at approximately 9:05 A.M..

This home is a single-story home with a fire clearance for (6) non-ambulatory residents. This home also has an approved Dementia Care Plan and a Hospice Waiver approved for (6) residents. There are currently (2) residents receiving hospice care. There are (3) residents receiving Home Health Agency services. LPA obtained a copy of a current liability insurance coverage.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Facility has an Infection Control Policy in place and was observed to be posted.

Operational Requirements: Facility is adhering to the operational requirements.

Physical Plant & Environment Safety: LPA toured facility grounds. Fire smoke alarms and carbon monoxide detector (located in the hallway) observed. The fire extinguishers were observed and appeared to be full (one located near the kitchen/dining area and one located inside the laundry room). Last drill was conducted on 01/22/25. Bedrooms have the required furniture. Ample supply of food (perishable and non-perishable) was observed. Ample linen supplies were also observed. Bathrooms have non-skid surfaces and grab bars. Hot water temperature measured at 106.8* and 107.4 * in the hallway bathrooms and 106.5* in the bathroom inside bedroom # 4. ***Refer to LIC 809C for the continuation of this report***.