Facility Evaluation Report

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 4 residents and the home currently has 6 residents, with 3 residents on hospice. Administrator (AD) Chris Landon arrived shortly to assist with the visit.

LPA along with staff toured the facility at 8:50 AM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 6 resident bedrooms, living room, dining room, and kitchen as well as 4 bathrooms. In addition, the garage is converted into an accessory dwelling unit with a built in bathroom and living quarters for staff. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. At 8:57 AM, LPA observed cleaning chemicals in an unlocked cabinet next to the refrigerator. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 119.4 degrees F and 120.3 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility did not have documented evidence of quarterly emergency drills for 2025.. Outside grounds were toured. Walkways around the home were clear of hazards. First aid kit contained all required items including tweezers, scissors and thermometer. Continued on LIC9099-C dated 11/14/2025