Facility Evaluation Report

Licensing Program Analyst (LPA) Lorena Casillas met with back up administrator Stephen Racine for an unannounced one (1) year Required visit for this facility.

LPA arrived at 09:30 am and was greeted by Administrator. All four (4) residents were present and in their rooms. LPA informed the Administrator of the purpose of the visit.

Infection control: LPA previously reviewed the facility mitigation plan (approved on 04/ 1 5/21) to make sure the licensee was following current infection control recommendations.

A tour of the physical plant was conducted with the Administrator at 9:50 am. The facility has six (6) bedrooms and two (2) bathrooms currently occupying four (4) residents. One (1) bedroom is designated for staff use only. The facility is Fire Cleared for six (6) ambulatory of which five (5) can be non-ambulatory, and a hospice waiver for four (4). Currently the facility two (2) residents on hospice.

Food Inspection: LPA conducted a tour of the kitchen around 10:00 am and observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. LPA observed all knives and sharp objects being locked and inaccessible to residents in care. The files and medication cabinet was observed to be locked and inaccessible to residents in care in a separate locked room near the entrance. There is a pantry located in the hallway that has a fridge for additional food storage.