Facility Evaluation Report

On June 6, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrator (AD) Michael Clayton was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Michael Clayton submitted an Administrator renewal application to the Administrator Certification Bureau (ACB) on June 4, 2024.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents with a hospice waiver for four. The facility is a single-story home with four private resident bedrooms, three shared resident bathrooms, a living room, a family room, a dining room, a kitchen, a laundry room, and an unattached two car garage. LPA accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed four residents in care and two staff present. LPA observed residents eating in the dining room as well as relaxing in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall in the resident hallway. LPA inspected the four private resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. All resident beds had clean linens and blankets. LPA observed additional linens are stored in hallway closet. LPA inspected the three shared resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 115.7 and 117.2 degrees Fahrenheit.

LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. CONTINUED ON LIC809-C