Facility Evaluation Report

On July 15, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required annual inspection utilizing the inspection tool. LPA met with Licensee and explained the purpose of the visit. LPA observed two residents in the common areas and two residents in their private rooms, Facility has four residents in care with no residents on hospice services. Facility is compliance to licensure.

Today's inspection, LPA and Licensee conducted a tour of the interior and exterior of the facility to ensure the health and safety of residents in care. Areas toured included but not limited to residents bedrooms, bathroom, laundry room, staff room, kitchen, backyard and the common areas. LPA observed facility to have amply supply of linens. LPA observed common areas to have the required posters. LPA observed facility to be at a comfortable temperature of 76*. LPA observed toxins to be locked and secured. LPA observed facility to have at least two days of perishable and seven days of nonperishable foods. LPA observed facility to be clean and in good repair.

File review of emergency drill revealed it was conducted on January 1, 2025, March 10, 2025 and June 20, 2025. LPA observed posted Administrator Certificate #7005717740 to be active with expiration date of 11/17/2024 to 11/16/2026. Emergency Disaster Plan was recently signed on April 14, 2025. LPA reminded Licensee to mark if plan was "reviewed" and/or "updated".LPA reviewed three resident files and three personnel files. LPA observed all required documents complete and present. LPA advised Licensee of Licensing's updated LIC602A, LPA informed Licensee the new LIC602A has additional information that satisfied the new neurocognitive disorder regulations. Inspection tool completed and no deficiencies cited.

At this time, LPA is requesting the following documents to be emailed to LPA: LIC 500, LIC 308 and liability insurance by Friday July 18, 2025.

Exit interview and a copy of the report was provided.