Facility Evaluation Report

At approximately 12:50 p.m. on 06/04/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the administrator and disclosed the reason for the visit.

The facility was last visited on 04/22/24 for an annual visit. It is a single story building with seven (07) bedrooms, three (03) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 ambulatory residents.

At 1:15 p.m. LPA reviewed client and personnel files. All files were complete and available for audit. At approximately 1:45 p.m., LPA observed Special Incident Reports (SIRs) involving Client #1 (C1) and Client #2 (C2) from 03/01/25 and 04/03/25 which were not sent to Community Care Licensing (CCL). This deficiency is cited on the LIC 809-D page.

LPA observed a maintained front yard. Postings in the office area included the facility sketch, confidential complaint contacts, facility license, grievance procedure, personal rights, house rules, COVID precautions, grievance procedure, weekly menu, and activity schedule. A screening station near the living room contained a digital thermometer, hand sanitizer, N95 masks, surgical masks, and gloves.

The facility has seven (07) private bedrooms. Bedroom #7 served as a staff room and was locked and free of hazards. All bedrooms were tidy and contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition.