Facility Evaluation Report

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Nick's Maple Home III to conduct an unannounced complaint visit for 56-AS-20230426163659. During visit, LPA observed deficiencies not related to the complaint allegations.

At approximately 2:17pm, upon arrival to the facility, LPA observed an individual inside the facility's attached garage. LPA introduced self and stated purpose of the visit. The individual identified themselves as Amir Mangaoang. LPA was informed that Amir works at the facility as a handy man. During, the visit, LPA completed a walkthrough of the facility and completed a record review. LPA observed Amir Mangoaoang did not have a fingerprint clearance. This poses an immediate health and safety risk to residents in care. LPA also observed a window ajar on the second floor of the facility. The window was observed did not have a screen on it. Staff informed LPA, the room belongs to a resident in care. The screen was removed by a resident in care during a behavioral episode. This poses an immediate health and safety risk to residents in care.

At approximately, 2:25pm LPA walked through the facility's backyard and observed a broken window on the facility's second floor. The glass of the window has several was cracked in serval places. Each crack in the window leads to a small whole in the center.

Based on observations and interviews, two (2) deficiencies are being issues to address the above concerns. A Civil Penalty was assessed on 5/1/2023. Refer to LIC809-D for deficiencies cited. A copy of this report along with appeal rights are being reviewed with and provided to the facility representative. ** A Civil Penalty assessment accompanies the deficiency.