Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores and Office Technician (OT) Jade Xu conducted an unannounced annual investigation visit using the CARE inspection tool. LPA met with Nancy Mandic and explained the reason for the visit.

Facility is licensed to serve 66 residents over 59 years old of which 26 may be non-ambulatory and 40 may be bedridden. Facility is approved to retain/accept fifteen (15) hospice residents. Facility is a campus area with separate cottage buildings which are identify as the Ranch House (Dementia unit), the Hearth and Stewart Cottage (Assisted Living).

LPA, OT, and Nancy Mandic toured the facility and observed the following:

The Commons which consist of facility's kitchen, library, and dining area: The kitchen is currently under construction due to plumbing issues which started on September 2023. A temporary trailer kitchen is set up outside the dining area for meal preparation. The trailer has a walking refrigerator and a small freezer which stores food for the 2 days worth of perishables, and the pantry is currently in the administration building which stores 7 days of non-perishables. The dining room and library are clean with sufficient seating area. Upon exiting the building towards the independent living there are two ponds protected by wire over them and a 5ft fenced on the bridge. A fence pool is in the back.

The Hearth: Has it's own smaller dining room with a glass screen - fireplace, activities supplies are stored and accessible to resident. Three (3) private bedrooms were observed each have sufficient lighting, furniture, and bedding supplies. Bedroom #3 does not have a bed per residents choice. Bathrooms were observed in working condition, with skid mats/grab bars, and water temperature was tested between 102.7 - 108.6 degrees F., which is not within the required 105-120 degrees F.

The Ranch House (Dementia Unit): Has a kitchenette with a small refrigerator for snacks. Drawer was observed with a lock unlock during the visit with a pair of large scissors, and cleaning solution bottle was accessible to the residents next to the microwave. Medication room was locked.(CONTINUED ON LIC 809C)