Facility Evaluation Report

At 11:15 a.m. on 12/14/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the administrator and licensee and disclosed the reason for the visit. LPA, administrator, and licensee toured the facility inside and out at 11:45 a.m. No immediate health and safety hazards were observed during this visit.

A file review was conducted prior to today’s visit.

The facility was last visited on 10/18/2023 for a complaint visit. It is a single story building with four (04) bedrooms, two (02) bathrooms, kitchen. garage, common areas, and outdoor areas. It has an approved fire clearance for four (04) ambulatory residents.

At the main entrance, LPA observed a maintained front driveway. A screening station contained hand sanitizer, digital thermometer, masks, and a visitors log. Postings inside included COVID precautions, confidential complaint contacts, activity schedule, facility license, facility sketch with evacuation routes clearly labelled, personal rights, weekly menu, facility license, and grievance procedure.

The facility has four (04) private bedrooms. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition.

Walls, floors, windows, screens, and blinds were clean and in good repair. At 11:50 a.m. LPA measured the room temperature to be 77.7 degrees Fahrenheit. The living room contained a television, art supplies, emergency water supply, and exercise equipment. A locked closet contained hygiene supplies. Another closet contained an adequate supply of fresh linens.

The facility has 2 bathrooms. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 12:05 p.m. LPA measured the water temperature in Bathroom #2 to be 115.7 degrees Fahrenheit.