Facility Evaluation Report

Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility to conduct and unannounced Case Management Incident Follow Up. LPA entered the facility and was greeted by Robin Colton in Reception. LPA stated the purpose of the inspection. Colton brought LPA to Interim Executive Director (IED) Kathleen Olson's office. LPA stated they are following up on the Unusual Incident Reports submitted to CCL on 1/24/24 regarding both spouses in a married couple.

LPA obtained copies of the Admission Agreements, Resident Information Form and Resident Ledger pertaining to the couple. IED also provided LPA with a written list indicating each day the couple visited the facility for a meal. IED pulled these dates from Dining Room Meal Logs.

LPA also obtained from the facility staff the Case Number, Detective name and Police station associated with the incident. Additionally, LPA obtained a photo of the Coroner's Seal affixed to the couple's private residence.

Based on Record Review LPA determined the couple had been paying to rent a room at the facility since August 31, 2023. Based on interview with the IED, the residents paid to rent the room, visited the facility but resided at a private residence away from the facility.

LPA conducted a health and safety check and noted two panels missing from the ceiling tiles. IED stated the removed tiles sustained water damage during recent rain and were removed so they could dry. IED stated service has been scheduled to repair ceiling tiles. IED stated that when the couple moved in, they only moved in a few pieces of furniture and stated they would not be residing in the room and did not want to receive service. LPA toured the couple's room and noted a bed in each room, two wooden chairs in the living room and a wooden table in the living room. LPA observed no personal items, food or entertainment devices in the facility apartment. LPA obtained photos of the room. (Continued on LIC809C)