Facility Evaluation Report

On November 21, 2022, Licensing Program Analyst (LPA) Wendy Gibbs, conducted an unannounced required annual visit with a primary focus on Infection Control measures using the CARE Inspection Tools. Upon arrival at the facility, LPA Gibbs met with House Administrator Josephine Hauf, and explained the purpose of today’s visit. The facility is licensed for fourteen (14) residents, approved for six (6) non-ambulatory and eight (8) ambulatory; hospice waiver for six (6). Currently there are eight (8) residents in the facility and three (3) staff.

Structure The facility is a single-story home in a residential area. The facility has seven (7) bedrooms, one (1) staff room, four (4) restrooms (2 full baths, 1shower, and 1 just facilities), kitchen, 2 sitting areas, laundry area, attached garage and an outside sitting area.

Physical Plant Outside grounds were toured, LPA observed multiple chairs and tables with umbrellas for residents use. There were no bodies of water. Walkways around the home were clear of obstructions or hazards.

Bedrooms LPA inspected all bedrooms. All bedrooms had necessary furniture which included: bed, dresser, nightstand, chair, ample lighting, and a closet. All beds had the required linens, mattress cover, fitted sheet, top sheet, blanket, comforter, and pillows. There were additional blankets and comforters in resident’s closets as well as personal need items (diapers, wipes, mats, gloves).

Bathroom All bathrooms were in good working order. There was ample supply of hand soap, and paper towels. Each shower was clean and free of mildew and had secured grab bars, nonskid matts, and/or a chair available. Water temperature measured between 112.4-118.2 degrees Fahrenheit.