Facility Evaluation Report

The following is an amended document previously written on 4-15-2026: On 4-15-2026 at 10:15am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a follow up to a previous pre-licensing visit and review items necessary for the new proposed License for Alexa Home. LPA met with Administrator Arvin Davis and explained the purpose of the visit. The purpose of today's visit was to review previous deficiencies. The findings based on the visit are as follows:

1. First aid kit has been updated with current unexpired medications in place

2. A hot water caution signed has been placed above the sink in the kitchen

3. The Plan of Operation was available to review by LPA. Dementia care program and hospice care to be expanded and updated. Additionally, Licensee to add information on electronic medication monitoring system and diabetic care including insulin monitoring, glucose monitoring, and assistance with medication. 4. Admissions agreement specific to the newly proposed residential care facility for the elderly (RCFE) was not available to view. Licensee to submit to LPA via email.

5. Facility's current LIC 500 reflecting current staff has been updated as of 4-6-2026

6. Licensee has provided proof of payment and copy for current liability insurance as of 1-12-2026

7. LPA reviewed resident1 (R1) insulin orders and medication log sheets, as well as conducted staff interviews. Based on the record review and interviews, it was determined that Licensee will continue the process of submitting an exception request for R1 in regards to staff assisting with insulin pen. Procedures to include but not be limited to: Computer program used to determine insulin dosage, use of glucose monitor, staff procedures for assistance, and training procedures.

8. Bathroom 1 splash guard has been repaired, however, bathroom 2 continue to display pink mold despite staff's attempt to clean the area. Licensee to utilize an outside service to properly clean and treat molded areas.

9. Emergency and evacuation procedures were available to view by LPA

Correction to be submitted to LPA by 7/24/2026. LPA will return at a later time once corrections are made. An exit interview was conducted with Administrator and a copy of this report was provided.