Facility Evaluation Report

At 1:40 p.m. on 07/31/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. 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 07/23/2021 for an annual visit.

It is a single story building with 6 bedrooms, 3 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 may be bedridden in Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for 6. The facility uses surveillance cameras inside and out.

Entry: Upon entry, LPA observed a maintained front yard. A posting for the facility’s visitation policy hung on the front door. LPA observed postings for ombudsman contact, confidential complaints, administrator certificate, facility license, Emergency Disaster Plan, resident rights, and resident councils.

Screening: LPA was screened for infectious disease upon entry. The screening station contained a digital thermometer and visitor log. LPA advised to include columns for symptoms and vaccination records in the visitor log.

Bedrooms: The facility has 6 bedrooms. 5 are private and 1 is shared. Bedroom #1 has a sign posted: Oxygen in use – No smoking. Staff was observed providing care for resident. Bedroom #3 is designated for staff. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Evacuation routes were clearly labelled and posted in each room.