Facility Evaluation Report

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 (S1) at 8am. Administrator (AD) arrived on site and LPA explained the purpose of the visit.

The facility is a four bedroom, two bathroom single residential home with an approved fire clearance for six non-ambulatory and a hospice waiver for six residents. The facility currently has a census of six residents in care.

During today's visit LPA toured the facility and inspected the carbon monoxide and smoke detectors. Carbon monoxide and smoke detectors were operational. LPA observed four resident bedrooms and all rooms had the required furnishings. The resident bathroom hot water temperature measured 111.9 degrees Fahrenheit. The fire extinguishers were charged and serviced in October 2024. AD will have inspection company service the fire extinguishers today, January 30, 2026. The facility's last fire drill was conducted on December 1, 2025.

LPA toured the kitchen and observed appliances were in working order. Sharps and knives were secured in a locked drawer and hazardous chemicals and cleaning materials were secured beneath the kitchen sink. LPA retained a minimum of two days perishable and seven days non-perishables on hand. LPA observed emergency water and additional non-perishables in the garage. The facility was clean and no odors were detected.