Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 9:10 AM, LPA Tea was greeted and granted entry into the facility by the caregiver staff and explained the reason for the visit. Administrators (AD) Scott Messick and Ryan Roche arrived shortly to assist with the visit. Facility is licensed for 6 non-ambulatory residents, with a hospice waiver for six. Currently there are four residents, and three are on hospice during today's visit.

At 9:20 AM, LPA Tea reviewed four resident files and two staff files. Residents’ files and staff files contained all required documentation. Administrator certificates expire on December 1, 2025.

LPA Tea along with AD Messick and Roche toured the facility at 10:06 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of 5 resident bedrooms, which one is a shared room, 1 staff room, 2 full bathrooms, living room, family dining room, kitchen, laundry room and attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 112.6 Fahrenheit degrees and 113.3 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps secured in a drawer. LPA also observed toxin substances to be secured and locked and inaccessible to clients underneath the kitchen sink and garage. The fire extinguisher in the kitchen is fully charged. The facility’s last fire drill was conducted