Facility Evaluation Report

At 9:40 a.m. on 08/25/2022, Licensing Program Analyst (LPA) Nicholas Reed and Licensing Program Manager (LPM) Cassandra Harris conducted an announced prelicensing visit. LPA and LPM met with Administrator and disclosed the reason for the visit. LPA, LPM, and Administrator toured the facility inside and out.

It is a two story facility with 9 bedrooms, 9 bathrooms, pantries, common areas, lactation room, medication room and outdoor areas. It has an approved fire clearance for 16 residents, of which 2 may be non-ambulatory. The facility uses surveillance cameras inside.

LPA was screened for infectious disease upon entry. The screening station contained a digital thermometer, visitor log. The visitor log tracked contact information, temperature, and symptoms. LPA noted the visitor log should also document vaccination status. Postings included grievance procedures, personal rights, non-discrimination notice, confidential complaint contacts, emergency contacts, ombudsman contacts. activity schedule, and facility menu.

Walls, floors, ceilings, windows, and blinds were clean and in good repair. At 9:45 a.m. LPA measured the room temperature to be 73 degrees Fahrenheit. Past the screening station were an intake office and a mud room for sanitation. The mud room contained a shower which provided hot water. LPA measured the water to be 105.7 degrees Fahrenheit at 9:58 p.m. The mud room also contained a Zapp machine for sanitation. Janitor closets on the first and second floor were locked. Cleaning supplies were locked in the linen closet with extra linens and hygiene supplies. The facility has sufficient emergency water supplies in the stairwells. Emergency food supplies were located in the first floor pantry. The pantry contained sufficient supplies of perishable and non-perishable food. The pantry also contained two refrigerators, two freezers, cooking tops, and a retherm unit. At 10:17 a.m. LPA measured a refrigerator and freezer temperatures to be 31 degrees Fahrenheit and -5 degrees Fahrenheit, respectively. Sharps were locked in a drawer by the sink. The dining room outside of the pantry contained utensils, a sink, storage, and two computers.