Facility Evaluation Report

At 11:05 a.m. on 03/28/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out.

The facility was last visited on 03/08/2021 for a prelicensing inspection. The facility has an approved fire clearance for 6 non-ambulatory residents of which 1 may be bedridden in room #3 or room #4. Hospice waivers for 5 residents. The facility is a single-story building with 4 bedrooms, 2 bathrooms, living room, dining room, kitchen, laundry area, staff office, back yard, and garage. The facility serves residents with Dementia.

Safety: The facility has ramps at the front door and outside of Bedroom #3 and Bedroom #4. All ramps were stable with sturdy handrails. Emergency exit paths, located on the west and east sides of the facility, were free from hazards. Emergency exit doors used inward facing, self-closing latches which were unlocked. Emergency disaster plan and emergency evacuation routes posted and clearly labeled. Auditory alarms on 4 out of 4 doors were on and functioning. A fully charged fire extinguisher hung in the kitchen. LPA observed its receipt from 03/04/2022. At approximately 11:40 a.m. LPA tested smoke and carbon monoxide detector in the living room. The detector was hardwired to others in the building, and all functioned appropriately. The facility uses a call system which signals to the kitchen.

Entry: LPA entered the one main entrance. Upon entry, LPA observed a sign labeled “No Smoking - Oxygen in use”. LPA also observed a sign regarding the updated visitation policy.

Screening: LPA was screened for symptoms of infectious disease upon entry. LPA observed a sign instructing visitors to wash hands upon entry. The screening station contained a digital thermometer, surgical masks, and a visitor log.