Facility Evaluation Report

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. Facility is licensed for 6 non-ambulatory residents and a hospice waiver for 6. The facility is a one story house with 6 bedrooms, 1 staff room, 6 bathrooms, living room, laundry room, kitchen, dining room and an attached 2 car garage. The Administrator's certificate expires on July 30, 2026. LPA and staff toured the facility. LPA observed the See Something Say Something Poster (PUB 475) posted in the entry way of the facility. LPA observed the fireplace in the living room is blocked off by a piece of wood that has moved mounted in the opening, so the fireplace is not accessible and cannot be used. LPA observed the 4 burner cook-top lights unassisted. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. Knives are kept locked in a kitchen drawer. Medication is kept locked in a cabinet in the kitchen. Smoke detectors/carbon monoxide detectors tested operational. Staff reported that last fire (disaster) drill took place in January but there is no documentation for any disaster drill. LPA and staff inspected the resident rooms. LPA observed all resident rooms had the required bed linens and furniture. LPA observed Resident 1 (R1) had bed rails. Staff reported that R1 is no longer on hospice. LPA observed all bathrooms are clean and operational hot water measured 107.9 degrees Fahrenheit in the 2 shared bathrooms. LPA observed the garage is kept locked and used for storage of extra food and supplies. LPA and staff toured the backyard. No bodies of water observed. There are two shaded areas with chairs to sit outside. The exit gate is operational. No obstacles or hazards observed in the backyard. LPA reviewed 4 resident files and medications. LPA observed R1 did not have a doctor's order for bed rails in their file. LPA observed R1 did not have a pre-appraisal or a current appraisal/care plan. No other discrepancies observed. LPA reviewed 2 staff files, LPA observed Staff 1 (S1) had a negative TB test but did not have a completed health screening.