Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit and was greeted by two caregivers (S1 and S2). LPA observed a third person and was informed it was a family member of the two caregivers. Upon entry at 9:15 am, LPA observed the delayed egress notification was not working at the front door. LPA stated the purpose of the visit was to conduct an annual inspection. The staff confirmed there are six residents. The facility is licensed for five non-ambulatory residents and one (1) bedridden resident.

LPA Spaeth reviewed resident records at 10:00 am to 11:00 am. LPA Spaeth & caregiver toured the facility at 11:00 to 11:30 am.

Living Room . - When entering the facility, the living room is located to the right and is a room with three walls. LPA observed a curtain was used as a door. LPA observed the room is used as a staff room and contained two twin beds. At 9:30 am, LPA observed staff member's medication was sitting out on a dresser. At 9:33 am, LPA observed the caregiver locked the medication in the resident's medication cabinet.

Kitchen/Family Room - LPA Spaeth observed the kitchen and family room are combined. The facility contained a two day supply of perishable food and a seven day supply of non-perishable foods. The knives were locked in a kitchen cabinet. The cleaning solutions are securely locked underneath the kitchen sink. The fire extinguisher is located in the kitchen and is operable.

Medication - LPA observed the resident medications, and first aid kit, are safely locked in a kitchen cabinet. The resident and staff files were also locked in the cabinet.

Delayed Egress: LPA observed the delayed egress to all exits were turned off and not working.