Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent Required- 1 year visit. LPA met with Greg Tillman, Administrative Assistant and explained the purpose of the visit. Shortly after, Ian Baker, Administrator arrived and assisted LPA with the inspection. There are currently thirty four (34) residents residing in the facility. Facility is licensed to serve elderly residents age 60 and above, fire clearance approved for (72) non-ambulatory. Hospice approved for ten (10) residents, 87705 compliant. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Physical Plant/Environment Safety: The facility is a 2-story building located in a residential community. The facility consists of: First floor: Lobby, Administrative offices, Conference room, Supply room, Power/Telephone room, Kitchen, Janitor room and Elevator. Second floor: (36) resident bedrooms, Medication room, Library, Activities room, Staff room, Beauty shop, Doctor's office/Nurse station and Dining room. The interior and exterior physical plant was inspected. Kitchen was inspected, knives, sharps objects, cleaning supplies and toxic substances are inaccessible to residents. Exit doors are free of any obstruction and there are no pools or large bodies of water. There are cameras without audio in the hallways and common areas. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. LPAs tested hot water temperature in random resident rooms and water temperature readings measured within the required 105 - 120 degrees Fahrenheit.

Staffing: A total of twenty (20) staff members including the Administrator provide care and supervision to the residents. Staff employed are over the a ge of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. *****CONTINUED ON LIC809-C*****