Facility Evaluation Report

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit. 78 residents were present during the inspection.

The facility is a two level structure and licensed for 120 residents, of which 58 may be non-ambulatory (first floor only), and there’s a hospice waiver for 18. All residents on the second floor are ambulatory and do not require any assistance ambulating. Bedrooms: All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Grab bars are tightly secured to the wall. Hot water measured in the range of 111.7 – 118.6 degrees F. Kitchen: 3 of 6 burners are operational on the commercial gas stove. Sharps are secured to the wall. Refrigerator, freezer, food, temperature logs were present and readily available for review. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed. The facility receives two food deliveries a week. Emergency food and emergency water was observed.

Resident & Staff Files : Resident and staff files stored in the administrator’s office.

File Review: Nine resident files were reviewed during the visit, and nine staff files were reviewed.

Medications/First-Aid Kit: Resident medications are stored in a locked medication cart in the medication room.

Medication Review: Seven resident medications were reviewed during the visit. No discrepancies were noted. Medications are being administered as prescribed.