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 3 residents and the home currently has 5 residents, with 3 residents on hospice. Administrator (AD) Carmen Achim arrived shortly after. AD has a valid certificate that expires on 12/1/2025. AD provided updated liability insurance that expires on 5/30/2025.

LPA along with staff 2 (S2) toured the facility at 1:30 PM. 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, staff room, and kitchen as well as 8 bathrooms. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. At 1:36pm, LPA observed 2 large bottles of opened alcohol in the kitchen refrigerator. At 1:40pm, LPA observed 1 out of 4 electric stove burners non-operational. At 1:46pm, LPA observed scissors in an unlocked right drawer of the sink in the bathroom nearest to the living room. At 1:52pm, LPA observed clorox cleaner in an unlocked cabinet under the sink in the bathroom of bedroom 5. 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 107.7 degrees F and 110.8 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.