Facility Evaluation Report

On 11/9/2021 at 1:05pm Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a Required 1-year Annual Inspection. LPA COVID screened upon entry with staff one (S1) who confirmed no staff or residents have tested positive or shown symptoms within the past 10 days. LPA met with Administrator who arrived on cite shortly after LPA's arrival. LPA was allowed entry into the facility that is licensed to serve a total capacity of 6, today's census is 4. Three of three staff observed on site with criminal record clearance in Licensing Information System. LPA observed Administrator Certificate expires on 4/6/2023.

LPA interacted with a random number of residents during this visit and observed residents engaged in activities and group outing. The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed kitchen, restrooms, bedrooms, storage areas, and common living areas to be clean and in good repair. The temperature inside the facility was measured at 72*F which is within the required range of 68*F and 85*F, or in areas of extreme heat the maximum shall be 30*F less than the outside temperature. The hot water was measured at 113*F within regulatory range of is not less than 105*F and not more than 120*F. LPA observed the centrally stored medications, toxins and knives to be locked inaccessible to residents. The first aid kit observed in compliance containing at least the following: a current edition of an approved first aid manual, sterile first aid dressings, bandages or roller bandages, adhesive tape, tweezers, scissors, thermometers, and Antiseptic solution.

Facility handles P & I monies, LPA observed the log is maintained and there is no commingling of funds. LPA observed the facility conducts fire drills documented monthly.