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 2 residents on hospice. Administrator (AD) Ron Wilkes arrived shortly to assist with the visit.

LPA along with staff toured the facility at 10:40 AM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of 5 resident bedrooms, staff room, living room, dining room, kitchen, 4 bathrooms, along with an attached garage. 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 115.5 degrees F and 117.8 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. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances 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 conducts quarterly emergency drills. Outside grounds were toured. Walkways around the home were clear of hazards. There is shaded outdoor seating for residents. Exit gates are unlocked and operational. LPA observed the emergency food and water supply stored in the garage. LPA observed sharps stored in a locked cabinet in the garage. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise. LPA reviewed six resident files and two staff files. Continued on LIC809-C dated 11/25/2025