Facility Evaluation Report

On this day, Licensing Program Analyst (LPA) Kimberly Lyman 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 of which one may be bedridden. Facility has an approved hospice waiver for 6 residents and the facility currently has 6 residents, with 3 residents on hospice. Administrator Heather Edgington has a current administrator certificate expiring on 05/23/2027. Upon entry, facility appears clean, safe and sanitary.

LPA Lyman along with Caregiver Kurutz toured the facility at 12:31 PM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The facility consists of 4 resident bedrooms, living room, dining room, and kitchen as well as a staff room. 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 105 degrees F and 110.8 degrees F in all restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. 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. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the emergency disaster plan and plan is complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 12/21/2025. Outside grounds were toured. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. There is ample shaded seating for residents. First aid kit contained all required items including tweezers, scissors and thermometer as well as a first aid guide. Facility conducts activities in the form of exercise and music therapy. CONTINUED ON LIC 809C DATED 01/22/2026