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. Administrators Brigitte Fisk and Ryan Fisk were notified and arrived later and also assisted with the visit.

There are currently six residents in care, three 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 an attached garage. The facility has two shared rooms and two private rooms in addition to one staff room in use by the awake night staff. There are two bathrooms, one of which is en-suite to one of the shared bedrooms.All showers are equipped with grab bars and slip mats.

Bedrooms appeared clean and sanitary. There are postural supports in use throughout the facility. Hospice plans of care and physician orders reviewed. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary. Hot water temperature measured at 112F in one of the two bathrooms used for personal grooming.

LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning products and the laundry area are secured along with the medication central storage. Fire extinguishers are charged and mounted, with up-to-date maintenance documented on the attached tags. LPA tested the smoke and carbon monoxide detectors which were found to be operational. The attached garage is inaccessible to residents. CONTINUED ON FORM LIC809-C