Facility Evaluation Report

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced required annual visit. LPA met with administrator and explained the reason for this visit.

Upon entry LPA was properly screened using covid protocols. LPA had temperature checked and signed into facility log.

LPA conducted a physical plant tour from 9:10-9:30am. Facility has four bedrooms and three bathrooms. Four bedrooms and two of the bathrooms are for resident use. One bathroom is designated for staff and visitors. LPA observed all resident bedrooms and bathrooms to be appropriately furnished. Carbon monoxide and smoke detector are combination and hard wired throughout the facility and were functioning properly.

LPA observed the kitchen area for the ability to prepare and store food. LPA observed there to be a sufficient amount of perishable and non perishable food. Sharp objects were observed to be locked away and inaccessible. Medications are stored in a lock cabinet in the laundry area which is adjacent to the kitchen area. Common areas were observed to be properly furnished. LPA checked the backyard for clutter and debris. There is an additional non-attached dwelling unit on the property which is gated off from the facility. Administrator states she lives in the unit.

Facility has two residents that are receiving hospice services at this time. LPA observed one resident to have full bed rails but is not receiving hospice services.

Exit Interview conducted. Deficiency cited on LIC 809 D. Appeal Rights explained.