Facility Evaluation Report

At approximately 10:00 AM on 03/08/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced prelicensing inspection. LPA met with Licensee and disclosed the reason for the visit. LPA toured the facility inside and out.

This prelicensing inspection is conducted for a change of ownership with residents in care. The facility has an approved fire clearance for 6 bedridden residents. The facility has 6 bedrooms and 3 bathrooms. LPA observed functioning auditory alarms on all exits. LPA tested smoke detectors and carbon monoxide detector to be functional. A fully charged fire extinguisher hung near the kitchen. It was last inspected on 01/24/2022. An emergency evacuation map was posted near the kitchen. All hazardous items and chemicals were stored and locked.

LPA was screened for temperature and symptoms of COVID-19. Staff prompted LPA to record information in a visitor log. The facility had signs relating to COVID-19 hung throughout.

All rooms, furniture, ceilings, and floors were clean, temperate, in good condition, and free from odors. LPA observed postings at the dining area for resident rights, resident councils, confidential complaints, emergency evacuation procedures, emergency contacts, and ombudsman contacts. LPA also observed a free house telephone in the common area.

Bedrooms: Bedroom #1 and Bedroom #2 were occupied by bedridden residents. Both bedrooms contained oxygen and “No smoking – Oxygen in use” signs were posted on doors. Residents had full bed rails, and the Licensee noted having the necessary prescriptions. Bedroom #4 was a staff bedroom. The bedroom was unlocked and contained no hazardous items. Bedroom #5 was vacant. Bedroom #6 had a personal bathroom. All bedrooms contained lamps, nightstands, adequate storage, and beds with sufficient sheets, blankets, and pillows.