Facility Evaluation Report

Unannounced Annual visit made out to this facility on 10/16/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility staff persons, Kaye Elma and Joan Dickens, who were briefly interviewed at this time. This LPA requested that the facility staff go ahead and contact the facility designated Administrator to inform her that CCL was present at this time.

It was learned that there were (2) residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (5) residents under the care of hospice at any given time.

It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time.

It was learned that there was (1) resident receiving services through home health at this time.

Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.

Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time.

Kitchen drawers and cabinets were opened and reviewed.

Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured.

Additional food storage units located in the garage area were observed to be present and functional at this time.

Laundry area, located in the room next to the garage, was toured.