Facility Evaluation Report

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by designee. Designee informed Administrator of LPA visit. Administrator Certificate 7010783740 expires 11/17/27. All fees are current as of this time. Facility currently has four (4) residents in care none of which are currently on hospice.

At approximately 10:00am LPA and designee toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered and labeled with opened dates present. Kitchen cabinet under sink contains disinfectants and cleaning supplies. Cabinet has magnetic locking mechanism. All other cleaning products and laundry soaps are located in the garage and inaccessible to residents in care.

All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required bath mats and grab bars. Water temperature in sinks measured at 110.4 degrees F in the back bath and 111.2 in the front bathroom, both of which are within the allowable range of 105 to 120 degrees F.

Fire extinguishers were last inspected 4/23/26. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drill was conducted on 2/21/26. Facility has two (2) backup generators for use during a power outage.

At approximately 10:30am LPA conducted a review of four (4) staff records. LPA discussed with designee that training requirements include the subjects of postural supports and restricted conditions. Additionally, all