Facility Evaluation Report

At 1:45 p.m. on 05/03/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out.

The facility was last visited on 04/21/2022 for a Case Management visit. It is a single story building with 7 bedrooms, 5 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 residents, of which 5 may be non-ambulatory and 1 bedridden in Bedroom #6. The facility serves residents with dementia. Approved hospice waivers for 6.

Entry: At the main entrance hung a sign stating “No Smoking – Oxygen in use”. Once inside, LPA observed postings for confidential complaints, Ombudsman contact information, resident rights, resident councils, neighborhood policy, administrator certificate, and the facility license.

Screening: LPA was screened for infectious disease upon entry. The screening station contained digital thermometer, hand sanitizer, and visitor log. LPA suggested adding two columns to track visitor symptoms and proof of vaccination.

Bedrooms: The facility has 7 bedrooms. 1 bedroom is designated for staff. It was locked and free from hazards. All 6 resident bedrooms are private. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition.

Bathrooms: The facility has 5 bathrooms. 4 bathrooms were private and 1 was a shared bathroom. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 3:28 p.m. LPA measured the water temperature in the shared bathroom to be 105.7 degrees Fahrenheit.