Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced annual visit and was greeted by a caregiver and the Administrator. The facility is licensed as an adult residential facility for the elderly to serve three ambulatory residents, three non-ambulatory and one bedridden resident.

LPA reviewed resident's records at 10:10 am until 10:35 am and reviewed staff records at 10:35 am until 11:10 am.

LPA and the Administrator began the tour of the facility at 11:45 am until 12:25 pm. LPA observed the following:

Living Room – LPA Spaeth observed the living room contained comfortable seating and a television.

Kitchen/Dining room - The dining room and kitchen are combined. LPA Spaeth observed a seven-day supply of non-perishable food and a two-day supply of perishable foods. The fire extinguisher is located in the kitchen. LPA observed the knives were locked in a kitchen drawer, and the cleaning solutions were locked in a cabinet underneath the sink. The water temperature was tested at 12:19 pm and the temperature was 107.0 F.

Bathrooms – LPA Spaeth observed the bathrooms contained hand soap, grab bars, paper towels, and a trash can.

Bedrooms – LPA Spaeth observed there are six residents' bedrooms in the facility. The bedrooms contained bed, linens, night stand, chair, chest of drawers, and a night lamp.

Staff Room – LPA observed the staff room was locked.