Facility Evaluation Report

On 07/22/2024 at 12:05 PM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA Brown met with a staff and was granted entry to the facility. Licensee/Administrator Annie Jane Mikenas arrived at the facility during the visit. At the time of the visit there were three (three) staff present, and five (5) residents present.

The facility is a five (5) bedroom, two & half (2 & 1/2) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) bedridden residents, serving mentally disabled seniors. The facility’s approved for six (6) hospice waiver. The current census is five (5) residents. LPA Brown was accompanied by Staff #2 (S2) to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant : The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperatures in the bathroom to be at 110 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguishers were also observed at the facility. Posters such as personal rights, the CCLD complaint poster, labor laws, and the disaster plan were posted in a common area. Furthermore, LPA Brown observed the den converted to staff room. Deficiency will be issued. ***Continuation in LIC809C ***