Facility Evaluation Report

Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced annual visit on this date. LPA met with Staff and explained the purpose of the visit.

The facility is a single story structure with wheelchair accessibility. LPA observed all required signage prominently posted. LPA toured the facility indoors and outdoors including but not limited to dining room, living room, kitchen, garage, 2 bathrooms, 3 bedrooms and backyard. The facility is licensed for 6 clients. During the tour LPA observed sliding glass door in R1's room blocked by furniture and a stick was placed in the guide-rails of the door preventing it to open. Advisory given.

Hot water temperature was measured at 122.5 degrees Fahrenheit in resident's bathroom sink, which is not within the required range of 105 to 120 degrees. Fire extinguishers are current and in compliance with fire safety. Fire drill was conducted on 4/2026. Carbon dioxide monitor present. LPA reviewed 4 resident and 3 staff files, including criminal record clearances. During the resident file review LPA observed orders by the hospice physician for oxygen for R1 ordered on 6/5/2026 not administered. All staff today are associated to the facility. First aid kit was checked and is complete.

Deficiencies were cited as a result of today's visit. An exit interview was conducted and a report was left with the facility with appeal rights.