Facility Evaluation Report

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 4/16/25 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with staff and explained the purpose of the visit. LPA requested for staff to notify Administrator that LPA is present at the facility to conduct an annual inspection. Administrator spoke with LPA by phone an is unavailable to assist. Caregiver designee assisted LPA.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. The home is very clean and residents stated they are happy with care.

LPA reviewed 4 resident files. Files are complete and well organized. Advised documenting care plans reviews meetings attempted with resident or representative. LPA reviewed 2 staff files. 2 of 2 staff lack required documented training in the last 12 months.

LPA Provided documents regarding training requirements, updated regulations and collaborating with home health/ hospice.

Licensee will submit insurance certificate, updated dementia plan and current LIC 500.

As a result of this inspection, the following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.

Exit interview conducted with licensee and copy of report and appeal rights left at the facility.