Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by staff. LPA met with Erin Fisk, Administrator explained the nature of the visit.

The facility is a 7-bedroom, 2-bathroom, one-story house with an attached garage that is used for storage. There is a back yard with a patio cover for the residents. There are three (3) residents at the facility and there are no residents receiving hospice services currently.

LPA accompanied by caregiver began the tour of the inside and outside of the facility. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage cabinet located in the dining room. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care and observed the first aid kit. LPA inspected the facility bathrooms and LPA measured the hot water temperature which measured 114.4 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked in the laundry unit where door is kept always locked. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which