Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit on 10/31/2025 and was greeted by two caregivers. LPA stated the purpose of the visit was to conduct an annual inspection. The caregivers confirmed there are four residents. The facility is licensed for five (5) non-ambulatory residents and one bedridden resident.

LPA reviewed the resident files at 9:15 am until 9:45 am. LPA observed three out of four residents' files were missing documentation.

LPA Spaeth and the caregivers toured the facility at 10:00 am until 10:45 am

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 locked. The cleaning solutions were locked underneath the kitchen sink. The fire extinguisher is located near the kitchen and is operable.

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