Facility Evaluation Report

At 9:35 a.m. on 12/11/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and disclosed the reason for the visit. Staff called the licensee at approximately 9:45 a.m. to disclose the reason for the visit.

A file review was conducted prior to today’s visit.

The facility was last visited on 02/09/2024 for an annual visit. It is a single story building with four (04) bedrooms, two (02) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for four (04) residents, of which three (03) may be nonambulatory in Bedrooms #1, #2, and #3, and one (01) ambulatory in Bedroom #4.

At the main entrance, LPA observed postings for the administrator certificate, facility license, facility sketch, confidential complaint contacts, personal rights, house rules, staff list, resident list, emergency contacts, emergency disaster plan, grievance policy, and COVID precautions. A screening station was present near the front and contained a digital thermometer, masks, and a visitor log.

Walls, floors, windows, screens, and blinds were clean and in good repair. The living room contained a television, video game console, and furniture in good repair. A fireplace was turned off and appropriately grated. A linen closet at the end of the hallway contained adequate amounts of fresh linens and towels. At 9:50 a.m. the house telephone was called and deemed operational. At 10:00 a.m., LPA measured the room temperature to be 68.0 degrees Fahrenheit. At 10:05 a.m. LPA observed a fully charged fire extinguisher in the kitchen. It was purchased on 01/05/2024.