Facility Evaluation Report

Licensing Program Analyst (LPA) Abeye Duguma met with Eddi Provost for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 1:30 PM and the following was noted:

There is one entrance being utilized at the facility. The facility has a total of four (04) bedrooms and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory, of which one (01) maybe bedridden and a hospice waiver for two (02). The facility is currently occupying six (06) residents.

The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility has a swimming pool/body of water with appropriate locked fencing. The garage is currently being used for storage. Laundry detergents, cleaning agents and other toxins are locked away.

Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents.

The living and dining room are neat and clean. The facility maintains a comfortable temperature at 76°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen, observed to be fully charged and last inspected 07/02/2025. (continued on LIC 809-C)