Facility Evaluation Report

At approximately 8:45 AM Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct an annual inspection of this licensed senior care facility. LPA met with Licensee/Administrator Kelly Muelrath. The facility is single story, with 3 bedrooms and 2 bathrooms. Facility has a fire clearance for 6 non-ambulatory residents and Hospice waiver for 3. There are currently 6 residents in care, of which 3 have diagnoses of dementia and 2 are receiving hospice.

At approximately 8:55 AM LPA toured the building and grounds with Licensee/Administrator which were found to be at a comfortable temperature, clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity space & activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerator and freezers were clean, and food was stored properly. Toxins are stored in locked closet across from laundry room & in locked cabinets under kitchen-sink. Water temperature measured between 107.6 degrees F & 107.9 degrees F, within regulations of 105 degrees F and 120 degrees F at faucets accessible to residents. Bathrooms were equipped with necessary grab bars, and slip-resistant mats and shower chairs in both shower floors as required by Title 22 regulations. Fire extinguishers were last charged 1/8/2025. There are 7 hardwired combination smoke /carbine monoxide detectors last inspected 10/7/2025 along with 2 additional carbon monoxide detectors found to be operational. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure.

At approximately 9:45 AM, LPA reviewed 5 resident records and found all residents have current physician's reports & care plans. All resident records contained current and signed admission agreements and contained physician's medication orders for each resident, as well as all required documentation. Continue on LIC809