Facility Evaluation Report

At approximately 11:15 AM on 03/16/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. LPA met with Licensee and disclosed the reason for the visit. LPA and Licensee toured the facility inside and out.

The facility is a single-story building with 3 bedrooms, 2 bathrooms, living room, a garage which serves as a staff office, front yard, and back yard. The facility has a surveillance camera at the main entrance and motion detectors with auditory alarms at all exits. The facility has a fire clearance for 6 non-ambulatory residents and an approved hospice waiver for 1 resident.

At the front, LPA observed an unlocked gate at the eastern sidewalk entrance. Signs regarding the facility’s visitation policy and COVID symptoms were posted at the main entrance. Upon entry, LPA was screened for symptoms of COVID-19 and temperature checked. All staff were wearing surgical masks. Postings for personal rights, confidential complaints, non-discrimination notice, facility license, and Ombudsman contact were visible at the front. LPA also observed signs for the facility’s COVID practices near the kitchen.

Bedrooms: Bedroom #1 and Bedroom #3 were occupied, shared rooms with beds at least 6 feet apart for social distancing. Bedroom #2 is a vacant, private bedroom which the facility can use for isolation purposes. All bedrooms contained a chair, nightstand, lamp, dresser, adequate storage, and beds with adequate bedding.

Bathrooms: LPA observed grab bars around the toilet and shower, non-skid mats, fully stocked liquid soap, a handwashing instruction sign, a small trash can, and personal hand towels in the resident bathroom. Licensee reported that staff monitor provide supervision each time a resident uses the restroom. Staff also provide paper towels as needed. LPA recommended a trash can with a lid for infection control purposes.