Facility Evaluation Report

Licensing Program Analyst (LPA) Shira Stamps, met with administrator Eddie Provost for an unannounced one (1) year Required visit for this facility.

LPA arrived at 10:30 am and was greeted by caregiver Mylyn Streeks. Two (2) residents were observed in the living room watching TV. The rest of the residents were observed to be in their room sleeping, watching TV and/or resting. The Administrator arrived at 10:47 am. LPA informed the Administrator of the purpose of the visit. The Administrator stated she had an appointment later, and caregiver Mylyn Streeks can sign the report.

Infection control: LPA Stamps reviewed facility mitigation plan (approved on 04/21/21) to make sure the licensee was following current infection control recommendations. Upon arrival LPA was screened by the caregiver and asked all infection control questions. LPA was asked to sign-in and sanitize/wash hands.

A physical plant tour was conducted with Administrator at 10:50 am. The facility has five (5) bedrooms and two (2) bathrooms currently occupying six (6) residents. The facility is Fire Cleared for six (6) non- ambulatory, one of which may be bedridden.

LPA observed rooms to have the appropriate bedding. There is a night stand and sufficient lighting for each resident. LPA tested the exit doors auditory system and it was observed to be operational for each room.

At 10:58 am LPA observed all bathrooms to have non-skid matts, grab bars, and the appropriated wash your hands signs posted. Hot water was tested at 10:58 am and measured within regulation at 119.8 degrees F.