Facility Evaluation Report

On 06/05/25, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection. On 06/06/25, LPA conducted a subsequent unannounced annual continuation and met with Staff. The facility is licensed to serve six (6) non-ambulatory residents, of which one may be bedridden. The facility has a hospice waiver approved for six residents. Bedrooms #1, #2, and #4 are approved for non-ambulatory or bedridden residents. Annual fees are current.

The facility consists of five (5) resident bedrooms, two and one half (2 ½ ) bathrooms, kitchen with office space, family room/activity area, dining room, staff bedroom adjacent to the family room, and shaded patio. The facility is clean, sanitary, and in good repair.

The Co-Administrator accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed.

Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Beds and bedding were in good condition, adequate lighting provided, walls and floors were in good repair. Continue to LIC809-C.