Facility Evaluation Report

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Brian Schott was notified and arrived later to assist with the visit.

There are currently six residents in care, one of which is receiving hospice care. LPA observed residents relaxing in the facility's common living areas as well as in their respective bedrooms. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with a detached garage. The facility has one shared bedroom occupied by a couple and four private rooms in addition to one staff room. There are 3.5 bathrooms, 1.5 of which is en-suite to a bedroom. All showers are equipped with grab bars and slip mats.

Bedrooms appeared clean and sanitary. There are full rails for postural support in use for three individual residents, however only one of the three was admitted onto hospice. Hospice plan of care reviewed. One type B deficiency issued. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary. Hot water temperature measured at 118F in two of the bathrooms used for personal grooming and toileting care.

LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items and the medication central storage are stored securely along with most of the cleaning products. There are however multiple cleaning products left unsecured in and around the shared bathroom accessed from the dining room. CONTINUED ON FORM LIC809-C