Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced annual visit on 8/13/2025 and was greeted by the two caregivers. LPA stated the purpose of the visit was to conduct an annual inspection. Staff confirmed there is one resident living in the facility. The facility is licensed for six non-ambulatory residents. Room 1 is for staff use only, Room 2 for two non-ambulatory, Rooms 3 & 4 for one non-ambulatory, and Room 5 for one bedridden and one non-ambulatory resident.

LPA and the staff member toured the facility 10:20 am until 11:00 am.

Living/Dining Room – LPA observed the living room and dining room are combined. The living room area consists of comfortable seating. The dining room contained a dining room table with chairs. LPA observed a wood stove insertion within a lower level fireplace. The area was surrounded by a metal fencing that was locked.

Kitchen - The facility contained a seven day supply of non-perishable food and a two day supply of perishable foods. A locked kitchen cabinet contained resident medication containers and the first aid kit. The knives were locked in a drawer. A fire extinguisher is also located in the kitchen. The cleaning solutions were locked underneath the sink.