Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA arrived at facility and was greeted and granted entry into the facility by caregiver. LPA explained the reason for the visit. Administrator (AD) Amy Zuehl arrived shortly to assist with the visit. Facility is licensed for six non-ambulatory residents; one may be bedridden with a hospice waiver for six. Currently there are six residents, of which four are on hospice during today's visit.

LPA accompanied began the tour of the inside and outside of the facility. The home consists of five resident bedrooms, a staff room, two bathrooms, living room, family room, dining room, kitchen, laundry room and an attached garage. 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. There is additional food storage in the two additional refrigerators in the garage. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage closet located in the hallway. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA observed the first aid kit and advised Administrator to obtain a current version of the first aid manual. LPA inspected the facility bathrooms (2) and LPA measured the hot water temperature which measured 105.2 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