Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with staff and explained the reason for the visit. The administrator, Carina Demman, arrived shortly after to assist with the visit. The fire clearance is granted for six (6) residents, ages 60 and above. The rooms are cleared for non-ambulatory residents. Facility has a hospice waiver approved for (1) resident.

The facility is a single story house consisting of 7 bedrooms (5 resident rooms & 2 staff rooms), 3.5 bathrooms, living room, family room, dining room, and kitchen, laundry room, and an attached garage. The resident bathrooms have non-skid mats and grab bars. The facility is well maintained and has an outdoor area with a city view. The smoke detectors and carbon monoxide detector are operable. Knives, cleaning supplies, and medications are locked. Facility has sufficient space to accommodate indoor and outdoor activities. Sufficient food supplies of 2-day perishable and a week of non-perishable items are observed. Information for appropriate reporting agencies are posted. The facility can accept or retain residents with dementia. The liability insurance is current for the coverage of at least $1 million (per occurrence) and $3 million (total annual aggregate). LPA reviewed the licensee/administrator and (2) other staff file. The Administrator's certificate expires on 12/12/25. Staff have current CPR & First Aid certificates. They are fingerprint cleared and associated. LPA reviewed (6) resident files and their medications. The files contain the required documents and the medications are given as prescribed. The Emergency Disaster Plan is reviewed at least annually and facility is conducting drills monthly.

No deficiencies issued today. An exit interview was held. A copy of this report was given to the administrator.