Facility Evaluation Report

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Administrator Jennifer Hahn. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, of whom all may be bedridden. Hospice waiver for six (6). During today’s inspection there were five (5) residents in care.

LPA with staff toured the interior and exterior of the facility and inspected each room. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. LPA observed medications that were transferred into unlabeled containers for five (5) residents. The medications had been transferred from their originally received containers. No pools or bodies of water exist on the premises. Per Administrator Jennifer Hahn, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, fire extinguisher, and facility telephone were all in working order. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas.