Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 47 non-ambulatory residents, with a hospice waiver for twenty-seven. Currently there are 36 residents, zero on hospice during today's visit. The Assistant Administrator (AA), Paige Rohrer arrived later to assist during the visit.

LPA Tea reviewed seven resident files and three staff files. Resident files and staff files contained most of the required documentation. Just a minor issue, some resident files were missing Personal Rights and Medical Emergency consent forms. Upon review of records, the facility is up to date with the required quarterly emergency disaster drill, which was last conducted on August 25, 2025. The administrator’s certificate expires February 20, 2027.

LPA Tea along with AA Rohrer toured the physical plant. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a single-story unit building that consists of two hallways with 24 resident rooms and shared Jack and Jill bathrooms. The residents’ bathrooms were recently renovated. There are common areas, dining/activity room, resident shower rooms, and kitchen for meal preparation and food service. In the front of the facility is the courtyard where there is a shaded patio seating area for residents to enjoy. The kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Emergency food and water supplies were stored separately in storage closets in the hallway. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. The fire and smoke detectors are serviced and maintained by a third-party company. Fire extinguishers are fully charged throughout the facility. Resident bedrooms had the required furniture, bed