Facility Evaluation Report

At 9:30am, Licensing Program Analyst (LPA) Huma Rahimi arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with the staff. Vanisa Campbell, who granted access to the facility and Administrator Sylvia Jackson was contacted via phone. The Administrator arrived shortly after. LPA explained the reason for the visit.

At 9:45am LPA conducted a tour of the physical plant and observed the following:

Facility is licensed for capacity of six (6) non-ambulatory, of which one (1) may be bedridden (in room #1). Facility also has a hospice waiver for two (2) residents .

Kitchen: At approximately, 9:45 AM LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen drawer. LPA observed that all cleaning supplies and laundry detergents are locked under the kitchen sink. LPA observed a fire extinguisher hanging on the kitchen wall and fully charged and purchased on 01/23/2025. Laundry is located by the kitchen and the washer and dryer were actively running and operational.

Medications: At approximately, 9:50 AM LPA observed medications are centrally stored and locked in a kitchen cabinet. At 12:55 PM, during the medication review for Resident #1 (R1), LPA could not verify the accuracy of the medication administration due to the lack of incomplete Centrally Stored Medication Destruction Form. Administrator informed LPA that the Administrator did not complete the form and was unable to provide a reason.