Facility Evaluation Report

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management visit to conduct a health and safety check for the residents in care. LPA was greeted and granted entry by Staff #1 (S1) at 8:30am. LPA met with Administrator (AD) Eleazar "Eli" Cuyson and explained the purpose of the visit. The facility currently has three residents in care.

LPA toured the facility kitchen and observed sharps and knives are secured. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand . The facility was clean and no odors were detected. All utilities were in working order and appliances were operational.

While touring the facility, LPA visited and interviewed three of three residents regarding care provided. Two of three residents stated they were doing fine and there were no issues with care provided. One resident was unable to speak but was clean and dressed and was being fed during the visit. LPA also interviewed three of three staff members regarding care provided.

LPA obtained copies of the resident and staff rosters and the following documents for three of three residents: Identification and Emergency Information forms (LIC 601), Physician's Reports (LIC 602A), Resident Appraisals (LIC 603A) and Admissions Agreements. LPA provided payment information documentation to AD for licensing fees due.