Facility Evaluation Report

Licensing Program Analyst (LPA) Jacqueline Shaw Ross arrived to the facility to conduct a required annual inspection and was greeted by Administrator, Maryline Siadto. Licensee Garrett Welker arrived shortly. Present at the facility were two (2) staff and five (5) residents. The facility is approved for six (6) non-ambulatory elderly residents; age 60 and above of which one may be bedridden. Hospice waiver is approved for six (6) residents.

The facility is a nine (9) bedroom, four (4) bathroom one story house. Each resident has a private room. LPA toured the facility and conducted a general overall inspection of the facility inside and outside. Passageways were observed to be free of obstructions. LPA observed each bedroom to be clean and odor free with the required furnishings. Furniture throughout the facility was in good repair. The facility temperature was 75 degrees. Hot water temperature tested at 110.5 degrees Fahrenheit. Each bathroom contained grab bars for each toilet, bathtub and shower; and non-skid mats or strips in shower or bathtub.

LPA observed the kitchen in its entirety. The kitchen appeared clean and odor free. Dishes, cups, pots and pans were observed to be of good quality and quantity. The facility contains a sufficient supply of perishable and non-perishable foods. LPA observed the following and a technical advisory was given for each issue: Knives were stored in the dishwasher as a primary storage space, dishwashing and other cleaning items were stored under the sink in an unlocked cabinet, and one bottle of liquid medication was stored unlocked in the refrigerator. LPA explained to Administrator that these are safety hazards however due to the current census of all residents being bedridden, it is unlikely that residents would have access to these hazards. LPA advised, however, they should be locked and stored appropriately.