Facility Evaluation Report

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrators Erin Fisk and Mark Fisk and explained the reason for the visit. Mark Fisk's Administrator Certificate expires on January 26, 2028. Facility is licensed for licensed for 6 non-ambulatory and hospice waiver for three. Facility is a two story home with 5 bedrooms, 4 bathrooms, kitchen, dining room and living room. The second floor has an open loft area and a staff room. The second floor is off limits to residents. There is a gate blocking the staircase. LPA observed the signal system which can be heard from the kitchen and second story is operational. LPA observed the PUB 475 poster posted in the main entry way of the facility. LPA observed the kitchen has a 2 day supply of perishable food and a 7 day supply of non-perishable food on hand. LPA observed the medication is kept locked in a kitchen cabinet. LPA observed the knives are kept locked. The fire extinguisher in the kitchen is fully charged. The garage is kept locked and used for storage. LPA observed a 3 day supply of emergency food and water stored in the garage. LPA inspected the first aid kit. The first aid kit had all the required elements. Smoke detectors/carbon monoxide detectors tested operational. The last emergency drill was conducted on March 8, 2026. LPA observed the resident rooms have the required furnishings and bed linens. LPA observed all 4 bathrooms are clean and operational. Hot water measured 105.0 to 115.4 degrees Fahrenheit. LPA observed extra linens stored in the hall pantry. LPA toured the backyard. No bodies of water observed. There is a cover patio with chairs to sit outside. No obstacles and hazards observed in the backyard. LPA reviewed 6 resident files and medication. LPA observed all 6 resident files had the required documents. No discrepancies observed. LPA reviewed 2 staff files. Both staff members are background cleared and associated to the facility. Both staff members have CPR/First Aid training and the required 20 hours of training. No discrepancies observed in the facility files. No deficiencies are being as a result of this visit. An exit interview was conducted and a copy of the report provided.