Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Annual Inspection Visit. LPA explained purpose of visit to staff, who was requested by LPA to contact the facility Administrator, who arrived shortly thereafter.

Current census was 4 residents and residents were attending their respectable day programs.

Tour of the facility was conducted. Common areas were toured. Living area, recreation area, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were in good repair and able to meet the needs of the residents at this time.

Kitchen area was toured. Cabinets and drawers were opened and the contents were reviewed to make sure that there was an ample supply of cups, dishes, and all other items able to meet the needs of the residents at this time. Food supply was reviewed for adequate 2 day perishable and 7 day nonperishable food quantities.

First aid kit was reviewed and observed to contain all required components at this time.

Fire extinguisher was observed to have been annually inspected by the local fire extinguisher company, Fire Code, on 03/18/2022 and observed to be in compliance at this time. A tour of the resident bedrooms and restrooms was conducted. Resident bedroom furniture and furnishings were observed to be in good repair and able to meet the needs of the residents at this time.

Hot water temperatures was measured in kitchen sink to make sure that the hot water being dispensed was within the allowed range of 105-120 degrees.