Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit and was greeted by the Administrator Amy Frey. LPA stated the purpose of the visit was to conduct an annual inspection. The Administrator confirmed there are five residents. The facility is licensed for five (5) non-ambulatory residents and one bedridden resident.

LPA Spaeth reviewed the resident and staff files at 1:10 pm until 1:50 pm. LPA reviewed the medications at 1:50 pm until 2:00 pm.

LPA Spaeth and the Administrator toured the facility at 2:00 pm until 2:30 pm.

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

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

Medications: LPA observed the resident medications, first aid kit, and PPE supplies were safely locked in a hallway closet.

Garage – The garage was locked and contained the washer/dryer and laundry detergent. The emergency food and water are also located in the garage.