Facility Evaluation Report

Licensing Program Analyst (LPA) Kruz Long conducted a site visit for the annual inspection. Upon arriving at the facility, LPA met with Susana Harmon (Administrator) and explained the purpose of the visit. The facility is licensed to serve: TWELVE (12) NON-AMBULATORY CLIENTS. HOSPICE WAIVER APPROVED FOR THREE (3) RESIDENTS.

A tour of the single story facility contains the following: Living room, kitchen, dining room, 12 resident bedrooms, 6 bathrooms and a sun room.

During today’s visit, LPA observed the following: Physical Plant and Environmental Safety : Sufficient lighting, non-skid maps in all bathrooms, comfortable temperature, hot water temperature measured between 105 degree F to 120 degree F in the bathroom, all bathing facilities in operable condition, no bodies of water on the premises, no firearms on the premises, toxins stored inaccessible to residents. Smoke detectors/Carbon monoxide detectors are operable. Fire extinguisher mounted to the kitchen wall is fully charged. Operational Requirements : Facility has an approved fire clearance for non-ambulatory persons. Staffing : There is sufficient staff, the administrator is on the premises during normal business hours. Personnel Records - Training : Staff has criminal record clearance, staff have sufficient hours of training which includes current First aid/CPR training. Resident Records/Incident Reports : Admission agreement, medical assessment and appraisal observed. Planned Activities : Facility has sufficient space to accommodate indoor and outdoor activities, furnished areas is provided for relaxation of residents. Food Services : Perishable foods are stored in covered containers, toxins are stored separate from foods, kitchen is kept clean. Incidental Medical and Dental : Licensee provide assistance in meeting medical and dental needs for residents, all centrally stored medications is labeled and maintained in compliance with state and federal law. Disaster Preparedness : Last disaster drill was conducted and document on 09/23/22.

No deficiencies were observed during today's visit.

An exit interview was conducted and a copy of this report was provided to Susana Harmon.