Facility Evaluation Report

Licensing Program Analyst(LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE tool. LPA met with Kevin Taliaferro and explained the reason for the visit.

Facility is licensed to serve 310 non- ambulatory adults 60 and over, of which 25 may be bedridden. Facility has an approved hospice waiver for 30 residents. Facility consist of a lobby, dining room, bristo bar, library, commercial kitchen, medication office, a therapy room, garden area, several lounge rooms, game/puzzle room, activity rooms, a theater, and other common areas through the 4th floors. It consist of 4 floors each floor has assisted living, the 2nd floor has a dementia unit with outdoor patios and common areas.

LPA toured the facility with Kevin Taliaferro, the following domains were reviewed during this visit:

Infection Control : Facility maintains a copy of infection control. Housekeeping staff were observed maintaining sanitizing procedures. Staff files were not reviewed today.

Operational Requirements: Facility maintains a plan of operation, infection control plan, fire clearance. Facility is operating within the limitations of their license. A current liability insurance was observed.

Physical Plant/Environmental Safety: During facility's tour LPA observed all common areas in good repair. A total of 13 random assisted living residents' rooms and 2 resident rooms in the dementia unit. Each room was furnished, with sufficient lighting, and bedding supplies. Water temperature was tested in each resident's bathroom and tested between 105.0-118.5 degrees F., which is within the required 105-120 degrees F. Bathrooms were observed with grab bars and slip flooring in the showers. Medication is stored in medication carts locked and inaccessible to residents. Passageways, hallways, stairways are clear of debris and obstructions. Facility has a fire sprinkler system throughout. Fire extinguishers were observed and last checked on 5/9/25. Delay egress exit doors were observed in working condition. Elevators were observed in working. There are no large bodies of water. (CONTINUED ON LIC 809C)