Facility Evaluation Report

On 11/16/2022, Licensing Program Analyst (LPA) Wendy Gibbs conducted an unannounced annual required visit with a primary focus on Infection Control measures using the CARE Inspection Tool. LPA met with Kristi Simonian and explained the purpose of today’s visit. The facility is licensed to operate for five (5) elderly residents ages 60 and above. The facility is approved for five (5) non ambulatory of which two (2) can be under hospice care.

Structure The facility is a single-story structure located in a residential neighborhood. The facility consists of three (3) resident rooms, two (2) bathrooms, a living room area, a dining area, kitchen and an attached garage.

Physical plant There is a ramp leading up to the front door. There is a ramp out the back door to the back yard. There are a table and chairs for the residents use. All walkways were clear and free of obstruction and debris. The gates are easy to exit with egress systems on them. There are no bodies of water or obstructions on the premises.

Bedrooms All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked.

Bathrooms Bathroom 1 was in good working order. The shower had secured grab bars and nonskid mats. The water temperature measured 113.3 degrees Fahrenheit. Bathroom 2 was in good working order. Both sinks worked. The shower had secured grab bars and nonskid mats. The water temperature measured 114.2.