Facility Evaluation Report

Licensing Program Analyst (LPA) Nune Margaryan conducted an Annual Required visit and inspection of the facility. LPA met with Administrator and explained the purpose of the visit. During the visit, the CARE tool was used. The facility is licensed to serve 9 non ambulatory residents age 60 and above and has an approved Hospice waiver for 5 residents. Currently, there are four (4) residents in placement and 1 resident is in hospice care. Facility has a Dementia Program in place and a Food Service Waiver to prepare food off premises and transport to the facility.

The facility is a single home in a residential area, with a kitchen, living room, dining room, entry area, sun room area, 5 bedrooms 4 bathrooms, visitor's/staff bathroom, laundry area, a detached garage, front court, and a backyard area. LPA toured the facility. All indoor and outdoor passageways were free of obstruction. The front and backyard are well maintained. No pools and bodies of water on the premises. There is a shaded seating area for the residents located in the backyard. The kitchen was inspected. LPA observed all kitchen equipment to be clean and in working condition. Sharps are locked and inaccessible to residents. Cleaning solutions and disinfectants was observed locked in the laundry room. The common areas are clean and were properly furnished. Resident rooms were sanitary and had the required furniture and furnishings. There is closet space for clothing and other belongings. Extra clean linen was observed in the hallway closet. Resident's rooms have the required furniture, bedding supplies and sufficient lighting. Bathrooms (4) in resident's rooms are in working condition, have grab bars, and skid mats. Water temperature was tested in each, between 114.1 - 117.1 degrees F.