Facility Evaluation Report

Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced annual visit at this facility. LPA was greeted and granted access by staff #1 (S1). The administrator designee, Khristine Campbell met with LPA shortly after and LPA explained the purpose of the visit. The facility has an approved fire clearance for five (5) non-ambulatory and one (1) bedridden resident in Room #5 for a total capacity of 6. The facility has a Hospice waiver for two (2) residents.

A tour of the physical plant inside and out was conducted at 9:15 a.m., and the following was observed: At entry LPA observed a screening area where visitors can sign in, hand sanitizer, and face masks available. LPA observed appropriate postings on a wall by the front entrance.

Kitchen: LPA conducted a tour of the kitchen and observed there to be sufficient supply of two day perishables and seven day non-perishables foods, properly stored. Food storage and preparation areas are clean and clear of clutter. LPA observed all knives, sharp object, locked in a kitchen drawer inaccessible to residents in care. There is one (1) fire extinguisher located in the kitchen was fully charged with purchase date 02/12/2025. A first aid kit with an up-to-date manual was observed in a kitchen drawer. Centrally stored medications are maintained locked in a kitchen cabinet. There are cordless telephones available to residents.

Common areas: LPA observed the living area, breakfast nook and formal dining area to be clean and clear of clutter. The furniture was in good repair and sits the capacity of the facility. In the breakfast nook LPA observed games and hand therapy tools to assist residents with dexterity.