Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit and was greeted by two staff members. LPA stated the purpose of the visit was to conduct an annual inspection. Staff confirmed there are four residents living at the facility. The facility is licensed for six non-ambulatory resident of which one maybe bedridden. The facility has a hospice waiver for one resident.. The Licensee reported to the facility at 11:00 am.

LPA and the caregiver toured the facility at 10:10 am until 10:50 am. LPA observed the facility was neat and clean.

Common Areas – LPA observed the living room contained seating and a television. The dining room contained dining room table and chairs..

Kitchen – LPAs observed the knives were locked in a kitchen drawer. The medications and first aid kit were locked in a kitchen cabinet. LPAs observed a two-day supply of perishable foods and a seven day supply of non-perishable foods. The cleaning solutions were safely locked underneath the kitchen sink and the kitchen was clean.

Resident Bedrooms - There are four resident bedrooms which are furnished with a bed, linens, night stand, chest of drawers, light and a closet.