Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit and was greeted by the Administrator. LPA stated the purpose of the visit was to conduct an annual inspection. The Administrator confirmed there are three residents living in the facility. The facility is licensed for two (2) ambulatory and four (4) non-ambulatory residents and a hospice waiver for one resident.

LPA Spaeth and the Administrator toured the location at 11:00 am until 11:45 am

Common Areas – The living room and dining room are combined. The living room was furnished with comfortable seating. The dining room contained dining room table and chairs. The family room contained a television and comfortable seating.

Medications: LPA observed the resident medications were safely locked in a cabinet in the living room.

Kitchen – LPA observed a two day supply of perishable food and a seven day supply of non-perishable food items. The knives and cleaning solutions were locked underneath the kitchen sink. The fire extinguisher was located in the kitchen and was operable.

Hallway - The linens were located in a hallway cabinet.

Laundry Area – The laundry area contained the washer and dryer. The laundry detergent was locked in a cabinet above the washer.

Garage - LPA observed the garage was locked. The emergency food and water were stored in the garage. An additional refrigerator contained additional frozen food and dairy products.