Facility Evaluation Report

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit.

Structure: The facility is a two story building and serves Assisted Living and Memory Care residents.

The facility is licensed for 106 non-ambulatory residents, has a hospice waiver for 30, and a waiver for a secured perimeter. The census was 73 during the annual inspection and residents were observed in their rooms, the different activity rooms, dining areas, and exterior portions of the facility. Bedrooms: All resident bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Hot water measured in the range of 106.5 – 119.6 degrees F. Kitchen: The kitchen is locked and off limits to residents. Kitchen appliances are operational. Refrigerator/freezer log is available for review. Sharps are hanging on a wall near the stove. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed. The facility received two shipments a week from Costco, and two shipments each week from Dairy King.

Client & Staff Files : Resident and staff files stored in locked storage cabinets behind the central desk.

File Review: Six resident files were reviewed during the inspection and five staff files were reviewed during the visit.

Medications/First-Aid Kit: Resident medications are stored in a locked medication room behind the central desk.

Medication Review: Six resident medications were reviewed during the inspection. No discrepancies were noted. Medications are being administered as prescribed.