Facility Evaluation Report

Licensing Program Analyst (LPA) Cassie Yang arrived at the facility to conduct an annual continuation case management visit. LPA met with Administrator and explained the purpose of the visit.

Facility is licensed for six non-ambulatory residents, hospice waiver of two. Today's visit, there are five residents with one resident on hospice.

Today's inspection, LPA observed fire extinguisher present with recent service date of August 25, 2025. LPA conducted a file review for three resident records. LPA observed resident records to be complete. LPA advised Administrator that moving forward facility should use the most updated LIC602A to ensure facility is in compliance with dementia regulations.

CARE tool was completed with Administrator and found facility to be compliance during today's visit.

At this time, LPA is requesting a copy of facility liability insurance to be emailed to LPA by September 3, 2025.

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