Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection. LPA met with House Manager, Barbara Boiston and explained the purpose of the visit. The fire clearance is approved for six (6) non-ambulatory residents in bedrooms #1 - #3. Bedroom #4 is for staff use only. There is a hospice waiver approved for 6 residents.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools.

The facility is a single story home with 3 resident bedrooms, 1 staff room, 2 bathrooms, living room, dining room, laundry room, and kitchen. The spacious backyard has a shaded area. There is no swimming pool on the premises. Knives, sharps, and cleaning supplies are locked. The hot water temperature was measured between the required range of 105-120 degrees F. The facility has auditory devices at the exit doors. Sufficient food supplies of 2 day perishable and at least a week of non-perishable are observed. The kitchen is kept clean and sanitary. Smoke and carbon monoxide detectors are operational. The facility is continuing to follow their Infection Control plan. Staff are wearing gloves to assist residents. The facility has a dementia care plan to accept or retain residents with dementia. There are currently 6 residents residing at the facility. There is sufficient space to accommodate indoor and outdoor activities. Liability Insurance in the amount of ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current.

LPA reviewed 3 personnel files. Administrator's (Briana McGee) certificate expires on 11/19/25. Staff have current CPR & First Aid certificates. They are receiving on-going training. LPA reviewed 6 resident files and their medications. Files are complete and medications are given as prescribed. The Emergency Disaster Plan is reviewed annually and drills are being conducted.

No deficiencies were issued. An exit interview was held and a copy of this report was given to B. Boiston.