Facility Evaluation Report

On 04/24/2024, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Annual Visit to the facility listed above. LPA met with Staff Daisy Bates and the purpose of today’s visit was explained. LPA was granted entry into the facility.

The facility is licensed to serve six (6) non-ambulatory residents, one (1) of which may be bedridden. The facility has an approved hospice waiver for six (6).

File Review LPA reviewed the files for six (6) residents and observed they have the required documents. LPA reviewed the files for the administrator and three (3) staff, and observed they have the required documents, training, clearance, and certification. LPA observed the administrator’s Administrator Certificate, number 7026237740, is valid till 05/13/2027. LPA informed staff Licensing Fees are due on 04/25/2026 and provided the PIN for online payment.

Medications LPA observed Centrally Stored Medications secured in a locked cabinet in the hallway. LPA observed Centrally Stored Medications in their original packaging. LPA reviewed Medication Administration Record (MAR) and Centrally Stored Medications for six (6) residents. LPA observed six (6) out of six (6) resident’s medications are consistent with properly documented records.

Due to the time, LPA will return at a later date to complete the Annual Visit.

During today’s visit, LPA did not observe or cite any deficiencies.

An exit interview was conducted with Staff Daisy Bates and a copy of this report was provided.