Facility Evaluation Report

On April 30, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to conduct the required annual inspection. LPA Mixson met with Administrator, introduced self, and stated the purpose of the visit. LPA Mixson toured the facility, along with the Administrator, and inspected the inside and outside of the facility. The facility is a single story home, and currently there are two residents, three staff. The facility has four bedrooms and two full baths. There is a kitchen, dining room, and living room. Additionally, the facility has a two car garage and a back yard.

Physical Plant: The physical plant, is in good condition, neat, and orderly. The lawns and shrubbery are well maintained. Outdoor and indoor passageways are free of obstruction at the time of this visit. Residents bedrooms have the required bedding and furniture; such as clean mattresses, night stands, storage space, and sufficient lighting. The bedroom temperatures were comfortable. All resident bedrooms were equipped with the required items. The Administrator tests the hot water temperature monthly and it tested within the required regulation. The restrooms were equipped with non-skid surfaces, and grab bars. LPA Mixson toured the kitchen and dining area. The facility had a menu posted and available for review. Kitchenware was in good condition and stored safely. Emergency food and water are available. LPA Mixson inspected the common areas. Smoke detectors are tested monthly, and are battery operated. The fire extinguishers were in the green and the factory seals had not been broken, and all are operable. Carbon monoxide alarms, along with smoke detectors were observed, and showed a green lights. Fireplace has screen, is covered, and is clean. There was a locked and centralized storage area for medications. Medications are ordered through a pharmacy that utilizes bubble packs. The facility had a designated area for resident and staff files, and it was lockable. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. There was adequate seating in the common areas and sufficient space for activities. LPA Mixson observed a monthly activity calendar. LPA Mixson reviewed three staff files, two resident files, and conducted two staff interviews with the Administrator and Licensee. Additionally, LPA Mixson was not able to interview the two residents. There were no regulation violations observed during todays visit.

An exit interview was conducted and a copy of this report, along with the LIC 811, was provided to Administrator.