Facility Evaluation Report

Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a 1 year required visit. LPA identified themself and explained the purpose of the visit. The facility is licensed to serve 6 residents, ages 60 years and over, all of whom may be non-ambulatory and three (3) of whom may be bedridden. The facility currently has a total of (3) bedridden residents. The facility also has an approved hospice waiver for four (4) of which there are (2) residents receiving hospice services. LPA verified contact information, and will update accordingly in the Licensing Information System. The facility annual fees were due by 4/2/25 and have been paid, the governing body is active and is in good standing.

LPA conducted a tour of the interior and exterior areas of the facility, there were no pools or bodies of water observed. The passageways are free from obstruction. The water temperature was checked and measured at 105-113 degrees Fahrenheit. The smoke and carbon monoxide detectors were found to be operable. The food supply was sufficient, with a 2 day supply of perishable and a 7 day supply of non perishable food items. LPA observed for there to be suppositories in the refrigerator with the food. LPA provided guidance and the suppositories were moved to medical refrigerator in the locked medication closet during LPAs visit. The medications, sharps and chemicals were observed to be locked and inaccessible to residents in care. There are no known guns or ammunition on grounds. The fire extinguishers are due to be serviced next month, the last service was done 5/2/24. The facility did not have record of emergency disaster drills that have been conducted nor was there proof of liability insurance, as the current policy expired on 9/8/24. The items were requested at the beginning of today's visit and were not produced prior to the conclusion of the visit. Deficiency cited.

A file review was conducted of staff and resident files. The staff present at the facility were observed to have obtained criminal record clearance and to be associated to the facility. Only one staff present possessed valid