Facility Evaluation Report

Licensing Program Analyst (LPA) Amy Rodgers, made an unannounced visit to conduct the required Annual Inspection. LPA Rodgers was granted entry into the facility Licensee Lisa Sayre after identifying herself and stating the purpose of the inspection. According to the facility’s license, the facility serves six non-ambulatory elderly residents: ages 60 and above of which one (1) can be bedridden.

LPA was accompanied by staff during a tour of the facility, which was conducted inside and out and included a sample of resident bedrooms, common area, dining area. Exterior and interior passageways were free from obstructions. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Resident’s room temperatures were within a comfortable range. Hot water temperature at taps accessible to residents were all compliant. Each resident had clean and sufficient bed linens, towels, and washcloths. All residents’ rooms were equipped with required furnishings and appropriate lighting to ensure the comfort and safety of residents. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. Non-skid mats are present in the showers. Facility has a two-day supply of perishable and a seven-day supply of nonperishable food items. Medications are locked in a locked closet, not accessible to residents. Medications were labeled and kept in compliance with label instructions. LPA interviewed staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained all required documents.

No deficiencies were observed or cited at the time of visit

An exit interview was conducted and a copy of this report and Licensee/Appeal Rights - LIC 9058 (rev. 03/22) was provided to the , Licensee Lisa Sayre whose signature on this form acknowledges receipt of these documents.