Facility Evaluation Report

Licensing Program Analyst (LPA) Shannan Hansen arrived at 10:00 AM to complete an unannounced continuation of annual inspection and met with Paul Freisen, Executive Director. There is a total of 214 residents.

LPA initiated a file review of 5 staff records and reviewed centrally stored medication records to complete this annual inspection. During staff file review at approximately 10:30 AM it was revealed facility had not requested a clearance transfer for staff (S1) who had worked at facility since 1/9/2024, LPA contacted CCL RO that confirmed (see LIC 809-D & LIC421 BG for ICP). Staff (S1 & S2) did not have required current First Aid training/certificate (see LIC809-D).

**Civil Penalty assessed in the amount of $500.00.

LPA Hansen is requesting facility to update and submit the following documents by 6/30/2024 to CCL:

LIC 308 Designation of Facility Responsibility

LIC 610 Emergency Disaster Plan (if changes)