Facility Evaluation Report

On 01/25/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived unannounced at the facility to conduct a required 1-year annual inspection. LPA met with Executive Director (ED), Christal Anderson, (Administrator Certificate #6035240740 Exp. 02/02/24) and explained the purpose of the visit.

Facility is licensed for 57 non-ambulatory residents, hospice waiver of 11. Facility currently has 47 residents,

LPA and ED conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to: twelve (12) resident rooms, laundry room, kitchen, three dining rooms, Beauty Salon, Spa Room, medication room and common areas. LPA observed residents in common area with staff participating in activities. The residence was found to be clean, safe, sanitary and in good condition.

LPA observed the facility to have the mandated posters posted. Fire extinguishers are maintained and ready for emergency use. Facility has required food supplies. There are appropriate staff present to meet the needs of residents.

LPA conducted a file review of five (5) resident files and five (5) staff files. All files had the required documents. LPA also conducted four (4) staff interviews.

In areas toured, LPA did not observed any violation of health, safety and personal rights.

LPA completed the CARE tool and found the facility to be in compliance at this time. No deficiencies observed.

Exit interview conducted and a copy of the report was provided.