Facility Evaluation Report

Licensing Program Analyst (LPA) Ramin Hashemi conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Executive Director (ED) Janet Miller. The facility's license shows a maximum capacity of one hundred twenty-five (125) non-ambulatory residents, fifteen (15) of whom may be bedridden. Hospice waiver for fifteen (15) and the facility is approved for delayed egress on the first floor. During today’s inspection there were one hundred and seventeen(117) residents in care.

During today’s visit, LPA with ED toured the interior and exterior of the facility, and inspected a sample of rooms. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per ED, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

No deficiencies were cited during the inspection. An exit interview was conducted with ED Miller to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.