Facility Evaluation Report

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 6/12/24 at 3:00pm and met with Dan Dines, Administrator and stated the purpose of the visit. This visit is to conduct a Required - 1 Year Inspection. LPA was allowed entry into the facility that is licensed and fire cleared for a capacity of 4 Non ambulatory residents. Administrator certificate expires 11/30/2024.

LPA toured and inspected the physical plant inside and outside to ensure there are no health and safety concerns. LPA observed the kitchen area, common areas, bathroom(s), activities room(s) and storage areas. LPA observed knives/sharps area to be locked. LPA observed required furniture, and lighting throughout the facility. The hot water temperature measured at 106.7*F which is within the required range of 105-120*F. The temperature inside the facility measured at 68*F which is within the required range of 68-85*F. The most recent emergency drill was conducted on 6/8/24.

The first aid kit included supplies such as sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide.

LPA observed centrally stored medications area to be locked. LPA observed the fire extinguisher(s), smoke and carbon monoxide detector(s) and pull alarm system. Facility has central heating and air. LPA observed the area where the staff and resident files are kept and readily available for review.

LPA observed 2 staff and 2 client files and conducted interviews during this visit.